National trends and outcomes for the surgical therapy of ileocolonic Crohn's disease: a population-based analysis of laparoscopic vs. open approaches

Kelly Lesperance; Matthew J Martin; Ryan Lehmann; Lionel Brounts; Scott R Steele

doi:10.1007/s11605-009-0853-3

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National trends and outcomes for the surgical therapy of ileocolonic Crohn's disease: a population-based analysis of laparoscopic vs. open approaches

Journal article

Peer reviewed

National trends and outcomes for the surgical therapy of ileocolonic Crohn's disease: a population-based analysis of laparoscopic vs. open approaches

Kelly Lesperance, Matthew J Martin, Ryan Lehmann, Lionel Brounts and Scott R Steele

Journal of gastrointestinal surgery, Vol.13(7), pp.1251-1259

07/2009

DOI: 10.1007/s11605-009-0853-3

PMID: 19301075

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Abstract

The laparoscopic approach to Crohn's disease has demonstrated benefits in several small series. We sought to examine its use and outcomes on a national level. All admissions with a diagnosis of Crohn's disease requiring bowel resection were selected from the 2000-2004 Nationwide Inpatient Sample. Regression analyses were used to compare outcome measures and identify independent predictors of undergoing laparoscopy. Of 396,911 patients admitted for Crohn's disease, 49,609 (12%) required surgical treatment. They were predominately Caucasian (64%), female (54%), and with ileocolic disease (72%). Most had private insurance (71%) and had surgery in urban hospitals (91%). Laparoscopic resection was performed in 2,826 cases (6%) and was associated with lower complications (8% vs. 16%), shorter length of stay (6 vs. 9 days), lower charges ($27,575 vs. $38,713), and mortality (0.2% vs. 0.9%, all P < 0.01). Open surgery was used more often for fistulas (8% vs. 1%) and when ostomies were required (12% vs. 7%). Independent predictors of laparoscopic resection were age <35 [odds ratio (OR) = 2.4], female gender (OR = 1.4), admission to a teaching hospital (OR = 1.2), ileocecal location (OR = 1.5), and lower disease stage (OR = 1.1, all P < 0.05). Ethnic category, insurance status, and type of admission (elective vs. non-elective) were not associated with operative method (P > 0.05). A variety of patient- and system-related factors influence the utilization of laparoscopy in Crohn's disease. Laparoscopic resection is associated with excellent short-term outcomes compared to open surgery.

Confidence Intervals

Prognosis

Ileal Diseases - surgery

United States

Humans

Laparoscopy - economics

Middle Aged

Crohn Disease - surgery

Cost of Illness

Crohn Disease - mortality

Male

Laparotomy - economics

Postoperative Complications - mortality

Hospital Mortality - trends

Young Adult

Ileal Diseases - mortality

Colonic Diseases - surgery

Laparoscopy - methods

Laparoscopy - adverse effects

Statistics, Nonparametric

Adult

Female

Registries

Odds Ratio

Laparotomy - adverse effects

Databases, Factual

Length of Stay

Severity of Illness Index

Risk Assessment

Logistic Models

Treatment Outcome

Ileal Diseases - pathology

Colonic Diseases - pathology

Analysis of Variance

Laparotomy - methods

Crohn Disease - pathology

Survival Analysis

Aged

Colonic Diseases - mortality

Health Care Surveys

Details

Title: Subtitle: National trends and outcomes for the surgical therapy of ileocolonic Crohn's disease: a population-based analysis of laparoscopic vs. open approaches
Creators: Kelly Lesperance - Department of Surgery, Madigan Army Medical Center, Fort Lewis, WA, USA. kelly025@comcast.net
Matthew J Martin
Ryan Lehmann
Lionel Brounts
Scott R Steele
Resource Type: Journal article
Publication Details: Journal of gastrointestinal surgery, Vol.13(7), pp.1251-1259
Publisher: United States
DOI: 10.1007/s11605-009-0853-3
PMID: 19301075
ISSN: 1091-255X
eISSN: 1873-4626
Language: English
Date published: 07/2009
Academic Unit: Surgery
Record Identifier: 9984051713402771

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