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A National study on the adoption of laparoscopic colorectal surgery in the elderly population: current state and value proposition

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Abstract

Background

The economic and clinical benefits of laparoscopic colorectal surgery are proven, yet may be underutilized in appropriate cases, especially in the elderly. Since the elderly constitute the greatest colorectal surgical volume, our goal was to identify trends in utilization and impact of laparoscopy in this cohort.

Methods

A national review of elective inpatient colorectal resections from the Premier Inpatient Database between 2010 and 2015 was performed. Patients were included if elderly (≥ 65 years), then grouped into open or laparoscopic procedures. The main outcome measures were trends in utilization by approach and total costs for the episode of care, length of stay (LOS), readmission, and complications by approach in the elderly. Multivariable regression models controlled for differences across platforms, adjusting for patient demographic, comorbidities and hospital characteristics.

Results

In 70,655 elderly patients evaluated, laparoscopic adoption remained lower than open throughout the study period. Rates increased until 2013, then declined, with increasing rates of open surgery. Laparoscopy was associated with significantly lower mean total costs ($4012 less/case), complications and readmissions (36% and 33% less, respectively), and shorter LOS (2.6 less days) than open cases (all p < 0.0001). When complications occurred, they were less severe and the readmission episodes were less costly with laparoscopy than open colorectal surgery.

Conclusion

The adoption of laparoscopy in the elderly has lagged behind open surgery and even declined in recent years despite being associated with improved clinical outcomes and reduced cost. With this tremendous value proposition to increase use of laparoscopic surgery in the elderly, further work needs to evaluate root causes of the disparity.

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Funding

The authors received no financial support or funding for this work.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, NewYork-Presbyterian, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 8th Floor, New York, NY, 10032, USA

    D. S. Keller

  2. Minimally Invasive Therapies Group, Medtronic, Inc., Boulder, CO, USA

    J. Qiu

  3. Division of Colorectal Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA

    R. P. Kiran

Authors
  1. D. S. Keller
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  2. J. Qiu
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  3. R. P. Kiran
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Correspondence to D. S. Keller.

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Ms. Qiu is employed by Medtronic, but there was no payment for the work. Dr. Keller: no conflicts of interest or financial ties to disclose. Dr. Kiran: no conflicts of interest or financial ties to disclose.

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Appendix

Appendix

See Tables 3, 4.

Table 3 Case selection and exclusions codes for colorectal surgery
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Table 4 Complications
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Keller, D.S., Qiu, J. & Kiran, R.P. A National study on the adoption of laparoscopic colorectal surgery in the elderly population: current state and value proposition. Tech Coloproctol 23, 965–972 (2019). https://doi.org/10.1007/s10151-019-02082-y

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