Elsevier

Surgery for Obesity and Related Diseases

Volume 9, Issue 1, January–February 2013, Pages 15-20
Surgery for Obesity and Related Diseases

Original article
Use of laparoscopy in general surgical operations at academic centers

Presented at the American Society for Metabolic and Bariatric Surgery Annual Meeting, June 20, 2012, San Diego, CA.
https://doi.org/10.1016/j.soard.2012.07.002Get rights and content

Abstract

Background

Laparoscopy is commonly being used in many different types of general surgical procedures. The aim of the present study was to examine the use of laparoscopy and perioperative outcomes in 7 general surgical operations commonly performed at U.S. academic medical centers.

Methods

The clinical data of patients who underwent 1 of the 7 general surgical operations from 2008 to 2012 were obtained from the University HealthSystem Consortium database. The University HealthSystem Consortium database contains data from all major teaching hospitals in the United States. The 7 analyzed operations included only elective, inpatient procedures (except for appendectomy): open and laparoscopic antireflux surgery for gastroesophageal reflux, colectomy for colon cancer or diverticulitis, bariatric surgery for morbid obesity, ventral hernia repair for incisional hernia, appendectomy for acute appendicitis, rectal resection for rectal cancer, and cholecystectomy for cholelithiasis. The outcome measures included the number of procedures, rate of laparoscopy, rate of conversion to laparotomy, and in-hospital mortality.

Results

During the 3.5-year period, 53,958 patients underwent bariatric surgery, 13,918 patients underwent antireflux surgery, 8654 patients underwent appendectomy, 8512 patients underwent cholecystectomy, 29,934 patients underwent colectomy, 17,746 patients underwent ventral hernia repair, and 4729 patients underwent rectal resection. The present rate of laparoscopic use was 94.0% for bariatric surgery, 83.7% for antireflux surgery, 79.2% for appendectomy, 77.1% for cholecystectomy, 52.4% for colectomy, 28.1% for ventral hernia repair, and 18.3% for rectal resection. In-hospital mortality was greatest for colorectal resection (.38%–.58%). In-hospital mortality for bariatric surgery (.06%) was comparable to that for appendectomy (.01%), cholecystectomy (.27%), antireflux surgery (.15%), and ventral hernia repair (.20%). The rate of laparoscopic conversion to open surgery was lowest for bariatric surgery (.89%) and greatest for rectal resection (16.4%).

Conclusion

Within the context of academic centers and elective, inpatient procedures, bariatric surgery had the greatest use of laparoscopy and the lowest rate of laparoscopic conversion to open surgery. The mortality for laparoscopic bariatric surgery is now comparable to that of laparoscopic cholecystectomy, ventral hernia repair, appendectomy, and antireflux surgery.

Section snippets

Discharge data set

The University HealthSystem Consortium (UHC) database is an administrative, clinical, and financial database that provides benchmark measures for the use of healthcare resources for the purpose of comparative data analysis among academic institutions. The UHC database is a collection of patient-level, abstracted data from academic health centers and affiliate community hospitals. It contains discharge information on the inpatient hospital stay, including patient characteristics, length of stay,

Results

The demographics of the patients undergoing the 7 general operations are listed in Table 2. Patients undergoing colorectal surgery tended to be older and to have more moderate and major severity of illness.

The use of laparoscopy among the 7 different general surgical operations is depicted in Figure 1. The rate of laparoscopy was 94.0% for bariatric surgery, 83.7% for antireflux surgery, 79.2% for appendectomy, 77.1% for cholecystectomy, 52.4% for colectomy, 28.1% for ventral hernia repair, and

Discussion

Data from a large cohort of patients who underwent 7 commonly performed inpatient general surgical operations at academic medical centers from 2008 to 2012 showed the greatest usage of laparoscopy for bariatric surgery and the lowest for rectal resection. The in-hospital mortality for bariatric surgery was comparable to that of laparoscopic cholecystectomy, ventral hernia repair, appendectomy, and antireflux surgery.

In the present study, we found 4 general surgical operations with >75%

Conclusion

Within the context of academic centers and elective, inpatient procedures, bariatric surgery has the greatest use of laparoscopy and the lowest conversion rate to open surgery. The in-hospital mortality of laparoscopic bariatric surgery is now comparable to that of laparoscopic cholecystectomy, ventral hernia repair, appendectomy, and antireflux surgery.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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