Utilization of Laparoscopic Colectomy in the United States Before and After the Clinical Outcomes of Surgical Therapy Study Group Trial
Utilization of Laparoscopic Colectomy in the United States Before and After the Clinical Outcomes of Surgical Therapy Study Group Trial
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DOI：
10.1097/sla.0b013e3182251aa3
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发表时间：
2011-08-01
影响因子：
9
通讯作者：
Herzig, Daniel O.
中科院分区：
文献类型：
--
作者：
Rea, Jennifer D.;Cone, Molly M.;Herzig, Daniel O.
目的：评价前瞻性资料支持下的腹腔镜结肠切除术(LC)在美国治疗结肠癌前后的应用情况。方法：对2001-2003年[手术治疗前临床结果(COST)]和2005-2007(成本后)全美住院患者的良性和恶性疾病择期结肠切除术样本进行查询。费用试验是在2004年公布的；因此，2004年的数据被排除在外。进行了单变量分析，包括患者特定变量、医院特定变量和结果变量。用多因素Logistic回归模型和子集分析对这些变量和手术方式的时间框架进行评估。结果：查询得到741,817例择期结肠切除术(684,969例开腹手术和56,848例腹腔镜手术)。随着时间的推移，通过腹腔镜行选择性结肠切除术的比例也在增加。良性疾病的腹腔镜结肠切除术从2001-2003年的6.2%增加到2005-2007年的11.8%，而结肠癌的手术则增加了更大的百分比，从2.3%增加到8.9%。在结肠癌患者的多变量模型中，与费用前相比，费用后进行腹腔镜手术的优势比(OR)为4.55(可信区间3.81-5.44)。相比之下，良性病变的OR值为2.10(可信区间1.79~2.46)。随着时间的推移，预测采用腹腔镜手术治疗癌症的因素变化很小：患者更有可能是男性，有保险，生活在收入最高的地区，并在城市教学医院接受手术。结论：在COST试验发表后的3年内，腹腔镜手术治疗结肠癌的使用接近良性疾病。然而，几乎90%的病例仍然是开放的，利用仍然受到社会经济因素的影响。
Objective: To evaluate the utilization of laparoscopic colectomy (LC) in the United States before and after prospective data supported its use for the treatment of colon cancer.Methods: The Nationwide Inpatient Sample 2001-2003 [ before Clinical Outcomes of Surgical Therapy (COST)] and 2005-2007 (after COST) was queried for elective colectomies for both benign and malignant disease. The COST trial was published in 2004; therefore, 2004 data were excluded. Univariate analyses including patient-specific, hospital-specific, and outcome variables were performed. Multivariate logistic regression models and subset analyses were used to evaluate these variables and operative approach by time frame.Results: The query yielded 741,817 elective colectomies (684,969 open and 56,848 laparoscopic). The percentage of elective colectomies performed laparoscopically has increased over time. Laparoscopic colectomy for benign disease increased from 6.2% in 2001-2003 to 11.8% in 2005-2007, while those for colon cancer have increased by a larger percentage, 2.3% to 8.9%. In a multivariate model of patients with colon cancer, the odds ratio (OR) for having a laparoscopic approach after COST was 4.55 (confidence interval 3.81-5.44) compared with before COST. In contrast, for benign disease, the OR was 2.10 (confidence interval 1.79-2.46). Factors predictive of having a laparoscopic approach for cancer have changed very little over time: Patients are more likely to be male, insured, live in areas with the highest incomes, and undergo resection at urban teaching hospitals.Conclusions: Within 3 years after publication of the COST trial, the use of laparoscopic resection for colon cancer approached that of benign disease. However, almost 90% of cases are still performed open and utilization remains influenced by socioeconomic factors.