Skip to main content

Advertisement

SpringerLink
Log in

Risk of readmission after laparoscopic vs. open colorectal surgery

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Laparoscopic colorectal resection (LC) is associated with known recovery benefits and earlier discharge when compared to open colorectal resection (OC). Whether earlier discharge leads to a paradoxical increase in readmission has not been well characterized. The aim of this study is to compare the risk of readmission after the two procedures in a large, nationally representative sample.

Methods

Patients who underwent colorectal resection in 2011 were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. LC and OC patients were compared for patient factors, complications, and readmission rates. A multivariable analysis controlling for significant factors was performed to evaluate factors associated with readmission.

Results

Of 30,428 patients who underwent colorectal resection, 40.2% underwent LC. Length of stay (LOS) after LC was shorter than after OC (5.7 vs. 9.7 days, p < 0.001). LC was associated with a significantly lower rate of surgical site infections (SSI), bleeding, reoperation, 30-day mortality, and complications. Risk of readmission was greater for patients undergoing proctectomy than colectomy (12.7 vs. 10.6 %, p < 0.001), but was lower after laparoscopic than open for both procedures after controlling for confounding factors. Obesity, DM, operating time ≥180 min, steroid use, and ASA class 3–5 were found to be associated with readmission.

Conclusion

Despite its technical complexity, LC can be performed without concerns for increased complications or readmission. The shorter length of stay and the lower risk of readmissions underline the true benefits of the laparoscopic approach for colorectal resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wick EC, Shore AD, Hirose K, Ibrahim AM, Gearhart SL, Efron J, Weiner JP, Makary MA (2011) Readmission rates and cost following colorectal surgery. Dis Colon Rectum 54(12):1475–9

    Article  PubMed  Google Scholar 

  2. Kerwel TG, Leichtle SW, Asgeirsson T, Hendren SK, Cleary RK, Luchtefeld MA (2014) Risk factors for readmission after elective colectomy: postoperative complications are more important than patient and operative factors. Dis Colon Rectum 57(1):98–104

    Article  PubMed  Google Scholar 

  3. Schneider EB, Hyder O, Brooke BS, Efron J, Cameron JL, Edil BH, Schulick RD, Choti MA, Wolfgang CL, Pawlik TM (2012) Patient readmission and mortality after colorectal surgery for colon cancer: impact of length of stay relative to other clinical factors. J Am Coll Surg 214(4):390–8

    Article  PubMed  Google Scholar 

  4. Rossi G, Vaccarezza H, Vaccaro CA, Mentz RE, Im V, Alvarez A, Quintana GO (2013) Two-day hospital stay after laparoscopic colorectal surgery under an enhanced recovery after surgery (ERAS) pathway. World J Surg 37(10):2483–9

    Article  PubMed Central  PubMed  Google Scholar 

  5. Geiger TM, Muldoon R (2011) Complications following colon rectal surgery in the obese patient. Clin Colon Rectal Surg 24(4):274–82

    Article  PubMed Central  PubMed  Google Scholar 

  6. Hardiman K, Chang ET, Diggs BS et al (2013) Laparoscopic colectomy reduces morbidity and mortality in obese patients. Surg Endosc 27:2907–10

    Article  PubMed  Google Scholar 

  7. Kwaan MR, Vogler SA, Sun MY et al (2013) Readmission after colorectal surgery is related to preoperative clinical conditions and major complications. Dis Colon Rectum 56(9):1087–92

    Article  PubMed  Google Scholar 

  8. Hoffman RL, Bartlett EK, Ko C, Mahmoud N, Karakousis GC, Kelz RR (2014) Early discharge and readmission after colorectal resection. J Surg Res S0022–4804(14):1–8

    Google Scholar 

  9. Rockall TA, Demartines N (2014) Laparoscopy in the era of enhanced recovery. Best Pract Res Clin Gastroenterol 28(1):133–42

    Article  CAS  PubMed  Google Scholar 

  10. Kiran RP, El-Gazzaz GH, Vogel JD et al (2010) Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from National Surgical Quality Improvement Program. J Am Coll Surg 211(2):232–8

    Article  PubMed  Google Scholar 

  11. Sharma A, Deeb AP, Iannuzzi JC, Rickles AS, Monson JR, Fleming FJ (2013) Tobacco smoking and postoperative outcomes after colorectal surgery. Ann Surg 258(2):296–300

    Article  PubMed  Google Scholar 

  12. Da Luz Moreira A, Kiran RP, Kirat HT, Remzi FH, Geisler DP, Church JM, Garofalo T, Fazio VW (2010) Laparoscopic versus open colectomy for patients with American Society of Anesthesiology (ASA) classifications 3 and 4: the minimally invasive approach is associated with significantly quicker recovery and reduced costs. Surg Endosc 24(6):1280–6

    Article  PubMed  Google Scholar 

  13. Turina M, Remzi FH, Dietz DW, Kiran RP, Seyidova-Khoshknabi D, Hammel JP, Vogel JD (2013) Quantification of risk for early unplanned readmission after rectal resection: a single-center study. J Am Coll Surg 217(2):200–8

    Article  PubMed  Google Scholar 

  14. Ifejika-Jones NL, Peng H, Noser EA, Francisco GE, Grotta JC (2013) Hospital-acquired symptomatic urinary tract infection in patients admitted to an academic stroke center affects discharge disposition. PM R 5(1):9–15

    Article  PubMed  Google Scholar 

  15. Thompson DA, Makary MA, Dorman T, Pronovost PJ (2006) Clinical and economic outcomes of hospital acquired pneumonia in intra-abdominal surgery patients. Ann Surg 243(4):547–52

    Article  PubMed Central  PubMed  Google Scholar 

  16. Catterick D, Hunt BJ (2014) Impact of the national venous thromboembolism risk assessment tool in secondary care in England: retrospective population-based database study. Blood Coagul Fibrinolysis 25:571–6

    PubMed Central  PubMed  Google Scholar 

  17. Morris DS, Rohrbach J, Rogers M, Thanka Sundaram LM, Sonnad S, Pascual J, Sarani B, Reilly P, Sims CJ (2011) The surgical revolving door: risk factors for hospital readmission. Surg Res 170(2):297–301

    Article  Google Scholar 

  18. Schmeida M, Savrin R (2013) Acute myocardial infarction rehospitalization of the medicare fee-for-service patient: a state-level analysis exploring 30-day readmission factors. Prof Case Manag 18(6):295–302

    Article  PubMed  Google Scholar 

  19. Brown JR, Parikh CR, Ross CS, Kramer RS, Magnus PC et al (2014) Impact of perioperative acute kidney injury as a severity index for thirty-day readmission after cardiac surgery. Ann Thorac Surg 97(1):111–7

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Authors’ contributions

Iyare O. Esemuede and Ravi P. Kiran made substantial contributions to the conception and design of the project as well as acquisition, analysis, and interpretation of data. Iyare O. Esemuede, Alodia Gabre-Kidan, Ravi P. Kiran, and Dennis L. Fowler made significant contributions to drafting and revising the article. Final approval of the version to be published was done by all four authors.

Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, 7 South Knuckle, New York, NY, 10032, USA

    Iyare O. Esemuede, Alodia Gabre-Kidan, Dennis L. Fowler & Ravi P. Kiran

Authors
  1. Iyare O. Esemuede
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alodia Gabre-Kidan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dennis L. Fowler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ravi P. Kiran
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ravi P. Kiran.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Esemuede, I.O., Gabre-Kidan, A., Fowler, D.L. et al. Risk of readmission after laparoscopic vs. open colorectal surgery. Int J Colorectal Dis 30, 1489–1494 (2015). https://doi.org/10.1007/s00384-015-2349-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-015-2349-9

Keywords

Search

Navigation