Can laparoscopy for colon resection reduce the need for discharge to skilled care facility?

Abhijit Shaligram, Lynette Smith, Pradeep Pallati, Anton Simorov, Jane Meza, Dmitry Oleynikov

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background A significant proportion of patients, especially the elderly undergoing colon resections, are likely to be discharged to a skilled care facility. This study aims to examine whether the technique of colectomy, open versus laparoscopic, contributed to their discharge to a skilled care facility. Methods This was a retrospective analysis using discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Adult patients who underwent colectomy in 2009 were evaluated. SAS and SUDAAN software were used to provide weighted estimates and to account for the complex sampling design of the NIS. We compared routine discharge to nonroutine discharge, defined as transfer to short-term hospital, skilled nursing facility, intermediate care, home health, or another type of facility. Results A weighted total of 221, 294 adult patients underwent colectomy in 2009 and had the primary outcome of discharge available. Of these colon resections, 70, 361 (32 %) were performed laparoscopically and 150, 933 (68 %) by open technique. A total of 139, 047 (62.8 %) patients had routine discharge and 73, 572 (33.3 %) nonroutine. A total of 8, 445 (3.8 %) patients died while in the hospital, and 229 (0.1 %) left against medical advice and were excluded from further analysis. On univariate analysis, age C65 years, female gender, Black/Hispanic race, open technique (compared to laparoscopic), Medicare/ Medicaid insurance status, comorbidity index of C1, and malignant primary diagnosis predicted nonroutine discharge. A multivariate logistic model was then used to predict nonroutine discharge in these patients using variables significant in the univariate analysis at the a = 0.05 significance level. In the multivariate analysis, open compared to laparoscopic technique was independently associated with increased likelihood of discharge to skilled care facilities (odds ratio 2.85, 95 % confidence interval 2.59-3.14). Conclusions In addition to the expected factors like advancing age, female gender, and increasing comorbidity index, open compared to laparoscopic technique for colectomy is associated with an increased likelihood of discharge to skilled care facilities. When feasible, the laparoscopic technique should be considered as an option, especially in the elderly patients who require colon resection, because it may reduce their likelihood of discharge to a skilled care facility.

Original languageEnglish
Pages (from-to)4038-4043
Number of pages6
JournalSurgical Endoscopy
Volume27
Issue number11
DOIs
StatePublished - Nov 2013
Externally publishedYes

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Laparoscopy
Colon
Colectomy
Comorbidity
Inpatients
Skilled Nursing Facilities
Insurance Coverage
Patient Discharge
Health Services Research
Medicaid
Home Care Services
Medicare
Hispanic Americans
Health Care Costs
Software
Multivariate Analysis
Logistic Models
Odds Ratio
Confidence Intervals
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Shaligram, A., Smith, L., Pallati, P., Simorov, A., Meza, J., & Oleynikov, D. (2013). Can laparoscopy for colon resection reduce the need for discharge to skilled care facility? Surgical Endoscopy, 27(11), 4038-4043. https://doi.org/10.1007/s00464-013-3052-y

Can laparoscopy for colon resection reduce the need for discharge to skilled care facility? / Shaligram, Abhijit; Smith, Lynette; Pallati, Pradeep; Simorov, Anton; Meza, Jane; Oleynikov, Dmitry.

In: Surgical Endoscopy, Vol. 27, No. 11, 11.2013, p. 4038-4043.

Research output: Contribution to journalArticle

Shaligram, A, Smith, L, Pallati, P, Simorov, A, Meza, J & Oleynikov, D 2013, 'Can laparoscopy for colon resection reduce the need for discharge to skilled care facility?', Surgical Endoscopy, vol. 27, no. 11, pp. 4038-4043. https://doi.org/10.1007/s00464-013-3052-y
Shaligram, Abhijit ; Smith, Lynette ; Pallati, Pradeep ; Simorov, Anton ; Meza, Jane ; Oleynikov, Dmitry. / Can laparoscopy for colon resection reduce the need for discharge to skilled care facility?. In: Surgical Endoscopy. 2013 ; Vol. 27, No. 11. pp. 4038-4043.
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abstract = "Background A significant proportion of patients, especially the elderly undergoing colon resections, are likely to be discharged to a skilled care facility. This study aims to examine whether the technique of colectomy, open versus laparoscopic, contributed to their discharge to a skilled care facility. Methods This was a retrospective analysis using discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Adult patients who underwent colectomy in 2009 were evaluated. SAS and SUDAAN software were used to provide weighted estimates and to account for the complex sampling design of the NIS. We compared routine discharge to nonroutine discharge, defined as transfer to short-term hospital, skilled nursing facility, intermediate care, home health, or another type of facility. Results A weighted total of 221, 294 adult patients underwent colectomy in 2009 and had the primary outcome of discharge available. Of these colon resections, 70, 361 (32 {\%}) were performed laparoscopically and 150, 933 (68 {\%}) by open technique. A total of 139, 047 (62.8 {\%}) patients had routine discharge and 73, 572 (33.3 {\%}) nonroutine. A total of 8, 445 (3.8 {\%}) patients died while in the hospital, and 229 (0.1 {\%}) left against medical advice and were excluded from further analysis. On univariate analysis, age C65 years, female gender, Black/Hispanic race, open technique (compared to laparoscopic), Medicare/ Medicaid insurance status, comorbidity index of C1, and malignant primary diagnosis predicted nonroutine discharge. A multivariate logistic model was then used to predict nonroutine discharge in these patients using variables significant in the univariate analysis at the a = 0.05 significance level. In the multivariate analysis, open compared to laparoscopic technique was independently associated with increased likelihood of discharge to skilled care facilities (odds ratio 2.85, 95 {\%} confidence interval 2.59-3.14). Conclusions In addition to the expected factors like advancing age, female gender, and increasing comorbidity index, open compared to laparoscopic technique for colectomy is associated with an increased likelihood of discharge to skilled care facilities. When feasible, the laparoscopic technique should be considered as an option, especially in the elderly patients who require colon resection, because it may reduce their likelihood of discharge to a skilled care facility.",
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AU - Oleynikov, Dmitry

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N2 - Background A significant proportion of patients, especially the elderly undergoing colon resections, are likely to be discharged to a skilled care facility. This study aims to examine whether the technique of colectomy, open versus laparoscopic, contributed to their discharge to a skilled care facility. Methods This was a retrospective analysis using discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Adult patients who underwent colectomy in 2009 were evaluated. SAS and SUDAAN software were used to provide weighted estimates and to account for the complex sampling design of the NIS. We compared routine discharge to nonroutine discharge, defined as transfer to short-term hospital, skilled nursing facility, intermediate care, home health, or another type of facility. Results A weighted total of 221, 294 adult patients underwent colectomy in 2009 and had the primary outcome of discharge available. Of these colon resections, 70, 361 (32 %) were performed laparoscopically and 150, 933 (68 %) by open technique. A total of 139, 047 (62.8 %) patients had routine discharge and 73, 572 (33.3 %) nonroutine. A total of 8, 445 (3.8 %) patients died while in the hospital, and 229 (0.1 %) left against medical advice and were excluded from further analysis. On univariate analysis, age C65 years, female gender, Black/Hispanic race, open technique (compared to laparoscopic), Medicare/ Medicaid insurance status, comorbidity index of C1, and malignant primary diagnosis predicted nonroutine discharge. A multivariate logistic model was then used to predict nonroutine discharge in these patients using variables significant in the univariate analysis at the a = 0.05 significance level. In the multivariate analysis, open compared to laparoscopic technique was independently associated with increased likelihood of discharge to skilled care facilities (odds ratio 2.85, 95 % confidence interval 2.59-3.14). Conclusions In addition to the expected factors like advancing age, female gender, and increasing comorbidity index, open compared to laparoscopic technique for colectomy is associated with an increased likelihood of discharge to skilled care facilities. When feasible, the laparoscopic technique should be considered as an option, especially in the elderly patients who require colon resection, because it may reduce their likelihood of discharge to a skilled care facility.

AB - Background A significant proportion of patients, especially the elderly undergoing colon resections, are likely to be discharged to a skilled care facility. This study aims to examine whether the technique of colectomy, open versus laparoscopic, contributed to their discharge to a skilled care facility. Methods This was a retrospective analysis using discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Adult patients who underwent colectomy in 2009 were evaluated. SAS and SUDAAN software were used to provide weighted estimates and to account for the complex sampling design of the NIS. We compared routine discharge to nonroutine discharge, defined as transfer to short-term hospital, skilled nursing facility, intermediate care, home health, or another type of facility. Results A weighted total of 221, 294 adult patients underwent colectomy in 2009 and had the primary outcome of discharge available. Of these colon resections, 70, 361 (32 %) were performed laparoscopically and 150, 933 (68 %) by open technique. A total of 139, 047 (62.8 %) patients had routine discharge and 73, 572 (33.3 %) nonroutine. A total of 8, 445 (3.8 %) patients died while in the hospital, and 229 (0.1 %) left against medical advice and were excluded from further analysis. On univariate analysis, age C65 years, female gender, Black/Hispanic race, open technique (compared to laparoscopic), Medicare/ Medicaid insurance status, comorbidity index of C1, and malignant primary diagnosis predicted nonroutine discharge. A multivariate logistic model was then used to predict nonroutine discharge in these patients using variables significant in the univariate analysis at the a = 0.05 significance level. In the multivariate analysis, open compared to laparoscopic technique was independently associated with increased likelihood of discharge to skilled care facilities (odds ratio 2.85, 95 % confidence interval 2.59-3.14). Conclusions In addition to the expected factors like advancing age, female gender, and increasing comorbidity index, open compared to laparoscopic technique for colectomy is associated with an increased likelihood of discharge to skilled care facilities. When feasible, the laparoscopic technique should be considered as an option, especially in the elderly patients who require colon resection, because it may reduce their likelihood of discharge to a skilled care facility.

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