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

Lesperance, Kelly; Martin, Matthew J.; Lehmann, Ryan; Brounts, Lionel; Steele, Scott R.
July 2009
Journal of Gastrointestinal Surgery;Jul2009, Vol. 13 Issue 7, p1251
Academic Journal
journal article
Purpose: 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.Methods: 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.Results: 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).Conclusions: 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.


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