Laparoscopic colectomy significantly decreases length of stay compared with open operation
Introduction Current literature tends not to adjust for biases in patient selection attributable to comorbidities that could provide alternate explanations for length of stay differences in laparoscopic versus open colectomy. We hypothesized that utilizing the National Surgical Quality Improvement P...
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| Veröffentlicht in: | Surgical endoscopy 2012, Vol.26 (1), p.144-148 |
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| creator | Stefanou, Amalia J. Reickert, Craig A. Velanovich, Vic Falvo, Anthony Rubinfeld, Ilan |
| description | Introduction
Current literature tends not to adjust for biases in patient selection attributable to comorbidities that could provide alternate explanations for length of stay differences in laparoscopic versus open colectomy. We hypothesized that utilizing the National Surgical Quality Improvement Program (NSQIP) dataset and acuity adjustment methods would demonstrate an independent improvement in length of stay for laparoscopic colectomy.
Methods
We used CPT coding to select all colectomies in NSQIP public use files from 2005–2009. Outlier status for surgical length of stay (SLOS) was defined as >75th percentile. Logistic regression analysis was used to predict this outlier status and linear regression to directly predict SLOS. Acuity adjustment was performed by using the most prevalent variables from multiple NSQIP annual reports. This work was done under the approval of our institutional review board and the data use agreement of the American College of Surgeons. Data were analyzed by using SPSS
®
.
Results
A total of 45,645 colectomies were reviewed, of which 12,455 (27.3%) were laparoscopic. The 75th percentile for SLOS was 11 days. This implied that 9,249 (27.9%) of the open colectomies were outliers, whereas only 1,152 (9.2%) of laparoscopic colectomies were outliers (
p
|
| doi_str_mv | 10.1007/s00464-011-1840-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_912273223</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2542465031</sourcerecordid><originalsourceid>FETCH-LOGICAL-c400t-4a52e89c9cd916d15ee304f5723d548265c537da0dab00a94292a0eed9c901b23</originalsourceid><addsrcrecordid>eNp1kMGKFDEQhoMo7uzqA3iRRhBPrVWVZHpylEVdYcCLXryETFI9ZulOt0kPMm9vhhldELykIPn-StUnxAuEtwjQvSsAaq1aQGxxo6A1j8QKlaSWCDePxQqMhJY6o67EdSn3UHGD-qm4IuwMdahW4vvWzS5PxU9z9I2fBvbLNB6bEvcp9tG7tAzHJrDP7AqXZuC0X340U9-UxR1rYKxxDs2veLqdOZ2O7JY4pWfiSe-Gws8v9UZ8-_jh6-1du_3y6fPt-23rFcDSKqeJN8YbHwyuA2pmCarXHcmg1YbW2mvZBQfB7QCcUWTIAXOoEcAdyRvx5tx3ztPPA5fFjrF4HgaXeDoUa5Cok0Sykq_-Ie-nQ051uAqhIY2yqxCeIV-1lMy9nXMcXT5aBHvSbs_abdVuT9qtqZmXl8aH3cjhb-KP5wq8vgCueDf02SUfywOntYa6WOXozJX6lPacHyb8_--_AYl6mkA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>911925137</pqid></control><display><type>article</type><title>Laparoscopic colectomy significantly decreases length of stay compared with open operation</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Stefanou, Amalia J. ; Reickert, Craig A. ; Velanovich, Vic ; Falvo, Anthony ; Rubinfeld, Ilan</creator><creatorcontrib>Stefanou, Amalia J. ; Reickert, Craig A. ; Velanovich, Vic ; Falvo, Anthony ; Rubinfeld, Ilan</creatorcontrib><description>Introduction
Current literature tends not to adjust for biases in patient selection attributable to comorbidities that could provide alternate explanations for length of stay differences in laparoscopic versus open colectomy. We hypothesized that utilizing the National Surgical Quality Improvement Program (NSQIP) dataset and acuity adjustment methods would demonstrate an independent improvement in length of stay for laparoscopic colectomy.
Methods
We used CPT coding to select all colectomies in NSQIP public use files from 2005–2009. Outlier status for surgical length of stay (SLOS) was defined as >75th percentile. Logistic regression analysis was used to predict this outlier status and linear regression to directly predict SLOS. Acuity adjustment was performed by using the most prevalent variables from multiple NSQIP annual reports. This work was done under the approval of our institutional review board and the data use agreement of the American College of Surgeons. Data were analyzed by using SPSS
®
.
Results
A total of 45,645 colectomies were reviewed, of which 12,455 (27.3%) were laparoscopic. The 75th percentile for SLOS was 11 days. This implied that 9,249 (27.9%) of the open colectomies were outliers, whereas only 1,152 (9.2%) of laparoscopic colectomies were outliers (
p
< 0.001). When optimizing a simple linear regression to predict SLOS, using common acuity adjustors (i.e., age, functional status, wound category, etc.), the variable marking open procedures consistently had a coefficient of 1.8, implying that open procedures increased SLOS by 1.8 days (
p
< 0.001). Utilizing logistic regression to predict outlier status, open colectomies were associated with an odds ratio of 3.79 for outlier status (
p
< 0.001), thus implying an independent effect on SLOS.
Conclusions
These results indicate that laparoscopic colectomy independently decreases SLOS compared with open colectomy. This study is unique in using statistical methods to control for selection bias of patients who might be more “surgically fit.”</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-011-1840-9</identifier><identifier>PMID: 21792714</identifier><identifier>CODEN: SUREEX</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Abdominal Surgery ; Aged ; Annual reports ; Biological and medical sciences ; Colectomy - methods ; Colectomy - statistics & numerical data ; Colonic Neoplasms - surgery ; Digestive system. Abdomen ; Diverticulum, Colon - surgery ; Endoscopy ; Female ; Gastroenterology ; General aspects ; Gynecology ; Hepatology ; Hospitals ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Laparoscopy ; Laparoscopy - statistics & numerical data ; Length of stay ; Length of Stay - statistics & numerical data ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Middle Aged ; Patients ; Proctology ; Quality improvement ; Regression analysis ; Review boards ; Stomach, duodenum, intestine, rectum, anus ; Surgeons ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Treatment Outcome ; Variables</subject><ispartof>Surgical endoscopy, 2012, Vol.26 (1), p.144-148</ispartof><rights>Springer Science+Business Media, LLC 2011</rights><rights>2015 INIST-CNRS</rights><rights>Springer Science+Business Media, LLC 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-4a52e89c9cd916d15ee304f5723d548265c537da0dab00a94292a0eed9c901b23</citedby><cites>FETCH-LOGICAL-c400t-4a52e89c9cd916d15ee304f5723d548265c537da0dab00a94292a0eed9c901b23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-011-1840-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-011-1840-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,4024,27923,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25550429$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21792714$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stefanou, Amalia J.</creatorcontrib><creatorcontrib>Reickert, Craig A.</creatorcontrib><creatorcontrib>Velanovich, Vic</creatorcontrib><creatorcontrib>Falvo, Anthony</creatorcontrib><creatorcontrib>Rubinfeld, Ilan</creatorcontrib><title>Laparoscopic colectomy significantly decreases length of stay compared with open operation</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Introduction
Current literature tends not to adjust for biases in patient selection attributable to comorbidities that could provide alternate explanations for length of stay differences in laparoscopic versus open colectomy. We hypothesized that utilizing the National Surgical Quality Improvement Program (NSQIP) dataset and acuity adjustment methods would demonstrate an independent improvement in length of stay for laparoscopic colectomy.
Methods
We used CPT coding to select all colectomies in NSQIP public use files from 2005–2009. Outlier status for surgical length of stay (SLOS) was defined as >75th percentile. Logistic regression analysis was used to predict this outlier status and linear regression to directly predict SLOS. Acuity adjustment was performed by using the most prevalent variables from multiple NSQIP annual reports. This work was done under the approval of our institutional review board and the data use agreement of the American College of Surgeons. Data were analyzed by using SPSS
®
.
Results
A total of 45,645 colectomies were reviewed, of which 12,455 (27.3%) were laparoscopic. The 75th percentile for SLOS was 11 days. This implied that 9,249 (27.9%) of the open colectomies were outliers, whereas only 1,152 (9.2%) of laparoscopic colectomies were outliers (
p
< 0.001). When optimizing a simple linear regression to predict SLOS, using common acuity adjustors (i.e., age, functional status, wound category, etc.), the variable marking open procedures consistently had a coefficient of 1.8, implying that open procedures increased SLOS by 1.8 days (
p
< 0.001). Utilizing logistic regression to predict outlier status, open colectomies were associated with an odds ratio of 3.79 for outlier status (
p
< 0.001), thus implying an independent effect on SLOS.
Conclusions
These results indicate that laparoscopic colectomy independently decreases SLOS compared with open colectomy. This study is unique in using statistical methods to control for selection bias of patients who might be more “surgically fit.”</description><subject>Abdominal Surgery</subject><subject>Aged</subject><subject>Annual reports</subject><subject>Biological and medical sciences</subject><subject>Colectomy - methods</subject><subject>Colectomy - statistics & numerical data</subject><subject>Colonic Neoplasms - surgery</subject><subject>Digestive system. Abdomen</subject><subject>Diverticulum, Colon - surgery</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>General aspects</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Laparoscopy</subject><subject>Laparoscopy - statistics & numerical data</subject><subject>Length of stay</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Proctology</subject><subject>Quality improvement</subject><subject>Regression analysis</subject><subject>Review boards</subject><subject>Stomach, duodenum, intestine, rectum, anus</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><subject>Treatment Outcome</subject><subject>Variables</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kMGKFDEQhoMo7uzqA3iRRhBPrVWVZHpylEVdYcCLXryETFI9ZulOt0kPMm9vhhldELykIPn-StUnxAuEtwjQvSsAaq1aQGxxo6A1j8QKlaSWCDePxQqMhJY6o67EdSn3UHGD-qm4IuwMdahW4vvWzS5PxU9z9I2fBvbLNB6bEvcp9tG7tAzHJrDP7AqXZuC0X340U9-UxR1rYKxxDs2veLqdOZ2O7JY4pWfiSe-Gws8v9UZ8-_jh6-1du_3y6fPt-23rFcDSKqeJN8YbHwyuA2pmCarXHcmg1YbW2mvZBQfB7QCcUWTIAXOoEcAdyRvx5tx3ztPPA5fFjrF4HgaXeDoUa5Cok0Sykq_-Ie-nQ051uAqhIY2yqxCeIV-1lMy9nXMcXT5aBHvSbs_abdVuT9qtqZmXl8aH3cjhb-KP5wq8vgCueDf02SUfywOntYa6WOXozJX6lPacHyb8_--_AYl6mkA</recordid><startdate>2012</startdate><enddate>2012</enddate><creator>Stefanou, Amalia J.</creator><creator>Reickert, Craig A.</creator><creator>Velanovich, Vic</creator><creator>Falvo, Anthony</creator><creator>Rubinfeld, Ilan</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>2012</creationdate><title>Laparoscopic colectomy significantly decreases length of stay compared with open operation</title><author>Stefanou, Amalia J. ; Reickert, Craig A. ; Velanovich, Vic ; Falvo, Anthony ; Rubinfeld, Ilan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-4a52e89c9cd916d15ee304f5723d548265c537da0dab00a94292a0eed9c901b23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Abdominal Surgery</topic><topic>Aged</topic><topic>Annual reports</topic><topic>Biological and medical sciences</topic><topic>Colectomy - methods</topic><topic>Colectomy - statistics & numerical data</topic><topic>Colonic Neoplasms - surgery</topic><topic>Digestive system. Abdomen</topic><topic>Diverticulum, Colon - surgery</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>General aspects</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Laparoscopy</topic><topic>Laparoscopy - statistics & numerical data</topic><topic>Length of stay</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Proctology</topic><topic>Quality improvement</topic><topic>Regression analysis</topic><topic>Review boards</topic><topic>Stomach, duodenum, intestine, rectum, anus</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Treatment Outcome</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stefanou, Amalia J.</creatorcontrib><creatorcontrib>Reickert, Craig A.</creatorcontrib><creatorcontrib>Velanovich, Vic</creatorcontrib><creatorcontrib>Falvo, Anthony</creatorcontrib><creatorcontrib>Rubinfeld, Ilan</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stefanou, Amalia J.</au><au>Reickert, Craig A.</au><au>Velanovich, Vic</au><au>Falvo, Anthony</au><au>Rubinfeld, Ilan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Laparoscopic colectomy significantly decreases length of stay compared with open operation</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2012</date><risdate>2012</risdate><volume>26</volume><issue>1</issue><spage>144</spage><epage>148</epage><pages>144-148</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><coden>SUREEX</coden><abstract>Introduction
Current literature tends not to adjust for biases in patient selection attributable to comorbidities that could provide alternate explanations for length of stay differences in laparoscopic versus open colectomy. We hypothesized that utilizing the National Surgical Quality Improvement Program (NSQIP) dataset and acuity adjustment methods would demonstrate an independent improvement in length of stay for laparoscopic colectomy.
Methods
We used CPT coding to select all colectomies in NSQIP public use files from 2005–2009. Outlier status for surgical length of stay (SLOS) was defined as >75th percentile. Logistic regression analysis was used to predict this outlier status and linear regression to directly predict SLOS. Acuity adjustment was performed by using the most prevalent variables from multiple NSQIP annual reports. This work was done under the approval of our institutional review board and the data use agreement of the American College of Surgeons. Data were analyzed by using SPSS
®
.
Results
A total of 45,645 colectomies were reviewed, of which 12,455 (27.3%) were laparoscopic. The 75th percentile for SLOS was 11 days. This implied that 9,249 (27.9%) of the open colectomies were outliers, whereas only 1,152 (9.2%) of laparoscopic colectomies were outliers (
p
< 0.001). When optimizing a simple linear regression to predict SLOS, using common acuity adjustors (i.e., age, functional status, wound category, etc.), the variable marking open procedures consistently had a coefficient of 1.8, implying that open procedures increased SLOS by 1.8 days (
p
< 0.001). Utilizing logistic regression to predict outlier status, open colectomies were associated with an odds ratio of 3.79 for outlier status (
p
< 0.001), thus implying an independent effect on SLOS.
Conclusions
These results indicate that laparoscopic colectomy independently decreases SLOS compared with open colectomy. This study is unique in using statistical methods to control for selection bias of patients who might be more “surgically fit.”</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>21792714</pmid><doi>10.1007/s00464-011-1840-9</doi><tpages>5</tpages></addata></record> |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Aged Annual reports Biological and medical sciences Colectomy - methods Colectomy - statistics & numerical data Colonic Neoplasms - surgery Digestive system. Abdomen Diverticulum, Colon - surgery Endoscopy Female Gastroenterology General aspects Gynecology Hepatology Hospitals Humans Investigative techniques, diagnostic techniques (general aspects) Laparoscopy Laparoscopy - statistics & numerical data Length of stay Length of Stay - statistics & numerical data Male Medical sciences Medicine Medicine & Public Health Middle Aged Patients Proctology Quality improvement Regression analysis Review boards Stomach, duodenum, intestine, rectum, anus Surgeons Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Treatment Outcome Variables |
| title | Laparoscopic colectomy significantly decreases length of stay compared with open operation |
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