F. Gani1, M. Cerullo1, J. K. Canner1, A. E. Harzman2, S. G. Husain2, W. C. Cirocco2, M. W. Arnold2, A. Traugott2, T. M. Pawlik1,2 1Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA 2Ohio State University,Department Of Surgery,Columbus, OH, USA
Introduction: Although the relationship between laparoscopic surgery and improved clinical outcomes has been well established across a variety of procedures, the effect of surgical “experience” with laparoscopic surgery remains less defined. The current study sought to assess the comparative benefit of laparoscopic colorectal surgery relative to surgeon “experience.”
Methods: Commercially insured patients aged 18-64 years undergoing a colorectal resection were identified using the MarketScan Database from 2010-2014. Individual surgeons were identified using surgeon-specific identifiers. For each surgeon, an annual surgical volume, and the degree of “experience” defined as the annual number of laparoscopic operations was calculated. Surgeons were categorized based on their annual laparoscopic surgical volume (1-4, 5-14, and ≥15 laparoscopic operations / year). Multivariable logistic regression analysis was used to calculate and compare postoperative mortality and morbidity relative to surgeon “experience.”
Results: A total of 34,066 patients were identified who met inclusion criteria. The median age of all patients was 53 years (IQR: 45-59) and 51.9% (n=17,689) patients were female. The average Charlson comorbidity index (CCI) score was 1.4 (SD=2.0) and 36.4% of patients presented with a CCI score ≥2. Laparoscopic operations were performed in 36.8% (n=12,522) of patients. Postoperative morbidity and mortality were 17.3% (n=5,875) and 0.9% (n=288), respectively. On multivariable analysis, laparoscopic surgery was associated with 70% decreased odds of developing a postoperative complication (OR=0.30, 95%CI: 0.28-0.32, p<0.001) and 84% lower odds of mortality (OR=0.16, 95%CI: 0.10-0.25, p<0.001). The comparative benefit of laparoscopic surgery was, however, greater among surgeons who had a greater experience with laparoscopic surgery. Compared with surgeons with less laparoscopic surgery experience (<5 laparoscopic operations / year), surgeons who had greater experience with laparoscopic surgery (≥15 laparoscopic operations / year) demonstrated a 33% lower odds for postoperative morbidity (OR=0.67, 95%CI: 0.62-0.71) and a 55% lower odds for postoperative mortality (OR=0.45, 95%CI: 0.33-0.62) when a laparoscopic approach was utilized (Figure).
Conclusion: Although laparoscopic surgery was associated with improved postoperative clinical outcomes, the effect of laparoscopic surgery was highly variable relative to surgeon experience with laparoscopic surgery.
