C. M. Hambleton Davis1,2, B. A. Shirkey3, L. W. Moore1, H. R. Bailey1, X. L. Du2, M. V. Cusick1 1Houston Methodist Hospital,Department Of Surgery,Houston, TX, USA 2The University Of Texas School Of Public Health,Department Of Epidemiology,Houston, TX, USA 3Oxford University,Oxford Clinical Trials Research Unit / Centre For Statistics In Medicine, NDORMS,Oxford, , United Kingdom
Introduction: Laparoscopy, originally pioneered by gynecologists, was first adopted by general surgeons in the late 1980’s. Since then, laparoscopy has been adopted in the surgical specialties and colorectal surgery for treatment of benign and malignant disease. Formal laparoscopic training became a required component of surgery residency programs as validated by the Fundamentals of Laparoscopic Surgery (FLS) curriculum; however, some surgeons may be more apprehensive of widespread adoption of minimally invasive techniques. Although an overall increase in the use of laparoscopic techniques is anticipated over a ten-year period, it is unknown if a similar increase will be seen in higher risk or more acutely ill patients.
Methods: Using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2014, colorectal procedures were identified by CPT codes and categorized to open or laparoscopic surgery. The proportion of colorectal surgeries performed laparoscopically was calculated for each year. Separate descriptive statistics were collected and categorized by age and BMI. ASA classification and emergency case status variables were added to the project to help assess complexity of cases.
Results: During the ten-year study period, the number of colorectal cases increased from 3,114 in 2005 to 51,611 in 2014 as more hospitals joined NSQIP. A total of 277,376 colorectal cases were identified, 114,359 (41.2%) of which were performed laparoscopically. The use of laparoscopy gradually increased each year, from 22.7% in 2005 to 41.2% in 2014. Laparoscopic procedures were most commonly performed in the youngest age group (18-49 years), overweight and obese patients (BMI 25-34.9), and in ASA Class 1-2 patients. Over the ten-year time period, there was a noted increase in the use of laparoscopy in every age, BMI, and ASA category, except ASA 5. The percent of emergency cases receiving laparoscopic surgery also doubled from 5.5% in 2005 to 11.5% in 2014.
Conclusion: Over a ten-year period, there was a gradual increase in the use of laparoscopy in colorectal surgery. Further, there was consistent increase of laparoscopic surgery in all age groups, including the elderly, in all BMI classes, including the obese and morbidly obese, and in most ASA classes, including ASA 3-4, as well as emergency surgeries. These trends suggest that minimally invasive colorectal surgery appears to be widely adopted and performed on more complex or higher risk patients.
