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Surgical Endoscopy

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01-12-2013

Optimizing cost and short-term outcomes for elderly patients in laparoscopic colonic surgery

Authors: Deborah S. Keller, Justin K. Lawrence, Tamar Nobel, Conor P. Delaney

Published in: Surgical Endoscopy | Issue 12/2013

Abstract

Background

Elderly patients often are regarded as high-risk for major abdominal surgery because of a lack of functional reserve and associated medical comorbidities. The goal of this study was to compare the cost of care and short-term outcomes of elderly and nonelderly patients undergoing laparoscopic colectomy. Our hypothesis was that elderly patients managed with laparoscopic colorectal surgery and an enhanced recovery protocol (ERP) can realize the same benefits of lower hospital length of stay (LOS) without increasing hospital costs or readmission rates.

Methods

Review of a prospective database identified all patients that underwent an elective laparoscopic colectomy from 2009 to 2012. Patients were stratified into elderly (≥70 years old) and nonelderly (<70 years old) cohorts. The main outcome measures were discharge disposition, hospital costs, hospital LOS, and 30-day readmission rates between the laparoscopic and open groups.

Results

A total of 302 nonelderly (66 %) and 153 elderly (34 %) patients were included in the analysis. The elderly cohort had significantly higher comorbidities than the nonelderly group. There were no mortalities. Operative variables (procedure time, blood loss, and intraoperative complications) were similar. At discharge, significantly more elderly patients required temporary nursing or home care. There were no significant differences in short-term outcomes of LOS, 30-day readmission rates, or costs for the episode of care between the two groups.

Conclusions

Combining laparoscopic colectomy with an ERP is cost-effective and results in similar short-term outcomes for the elderly and nonelderly patients. Despite higher comorbidities, elderly patients realized the same benefits of shorter LOS with similar hospital costs and readmission rates.

Peters WR, Fleshman JW (1995) Minimally invasive colectomy in elderly patients. Surg Laparosc Endosc 5(6):477–479PubMed

Iroatulam AJ, Chen HH, Potenti FM, Parameswaran S, Wexner SD (1999) Laparoscopic colectomy yields similar morbidity and disability regardless of patient age. Int J Colorectal Dis 14(3):155–157PubMedCrossRef

Stocchi L, Nelson H, Young-Fadok TM, Larson DR, Ilstrup DM (2000) Safety and advantages of laparoscopic vs. open colectomy in the elderly: matched-control study. Dis Colon Rectum 43(3):326–332PubMedCrossRef

Person B, Cera SM, Sands DR, Weiss EG, Vernava AM, Nogueras JJ, Wexner SD (2008) Do elderly patients benefit from laparoscopic colorectal surgery? Surg Endosc 22(2):401–405PubMedCrossRef

Tuech JJ, Pessaux P, Rouge C, Regenet N, Bergamaschi R, Arnaud JP (2000) Laparoscopic vs open colectomy for sigmoid diverticulitis: a prospective comparative study in the elderly. Surg Endosc 14(11):1031–1033PubMedCrossRef

Delgado S, Lacy AM, Garcia Valdecasas JC, Balague C, Pera M, Salvador L, Momblan D, Visa J (2000) Could age be an indication for laparoscopic colectomy in colorectal cancer? Surg Endosc 14(1):22–26PubMedCrossRef

Stewart BT, Stitz RW, Lumley JW (1999) Laparoscopically assisted colorectal surgery in the elderly. Br J Surg 86(7):938–941PubMedCrossRef

Law WL, Chu KW, Tung PH (2002) Laparoscopic colorectal resection: a safe option for elderly patients. J Am Coll Surg 195(6):768–773PubMedCrossRef

Pinto RA, Ruiz D, Edden Y, Weiss EG, Nogueras JJ, Wexner SD (2011) How reliable is laparoscopic colorectal surgery compared with laparotomy for octogenarians? Surg Endosc 25(8):2692–2698PubMedCrossRef

10.

Grailey K, Markar SR, Karthikesalingam A, Aboud R, Ziprin P, Faiz O (2012) Laparoscopic versus open colorectal resection in the elderly population. Surg Endosc 27(1):19–30PubMedCrossRef

11.

Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP (2011) Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 149(6):830–840PubMedCrossRef

12.

Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238(1):67–72PubMed

13.

Delaney CP (2008) Outcome of discharge within 24–72 hours after laparoscopic colorectal surgery. Dis Colon Rectum 51(2):181–185PubMedCrossRef

14.

Delaney CP, Brady K, Woconish D, Parmar SP, Champagne BJ (2012) Towards optimizing perioperative colorectal care: outcomes for 1,000 consecutive laparoscopic colon procedures using enhanced recovery pathways. Am J Surg 203(3):353–355 Discussion 355–356PubMedCrossRef

15.

Ballesta Lopez C, Cid JA, Poves I, Bettonica C, Villegas L, Memon MA (2003) Laparoscopic surgery in the elderly patient. Surg Endosc 17(2):333–337PubMedCrossRef

16.

Pedersen T, Eliasen K, Henriksen E (1990) A prospective study of mortality associated with anaesthesia and surgery: risk indicators of mortality in hospital. Acta Anaesthesiol Scand 34(3):176–182PubMedCrossRef

17.

Turrentine FE, Wang H, Simpson VB, Jones RS (2006) Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 203(6):865–877PubMedCrossRef

18.

Finlayson E, Wang L, Landefeld CS, Dudley RA (2011) Major abdominal surgery in nursing home residents: a national study. Ann Surg 254(6):921–926PubMedCrossRef

19.

Goh YC, Eu KW, Seow-Choen F (1997) Early postoperative results of a prospective series of laparoscopic vs. open anterior resections for rectosigmoid cancers. Dis Colon Rectum 40(7):776–780PubMedCrossRef

20.

Chen HH, Wexner SD, Weiss EG, Nogueras JJ, Alabaz O, Iroatulam AJ, Nessim A, Joo JS (1998) Laparoscopic colectomy for benign colorectal disease is associated with a significant reduction in disability as compared with laparotomy. Surg Endosc 12(12):1397–1400PubMedCrossRef

21.

Frasson M, Braga M, Vignali A, Zuliani W, Di Carlo V (2008) Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. Dis Colon Rectum 51(3):296–300PubMedCrossRef

22.

Bardram L, Funch-Jensen P, Kehlet H (2000) Rapid rehabilitation in elderly patients after laparoscopic colonic resection. Br J Surg 87(11):1540–1545PubMedCrossRef

23.

Bottino V, Esposito MG, Mottola A, Marte G, Di Maio V, Sciascia V, Nunziante M, Fregola G, Cuzzovaglia S, Galante F et al (2012) Early outcomes of colon laparoscopic resection in the elderly patients compared with the younger. BMC Surg 12(Suppl 1):S8PubMedCrossRef

24.

Pawa N, Cathcart PL, Arulampalam TH, Tutton MG, Motson RW (2012) Enhanced recovery program following colorectal resection in the elderly patient. World J Surg 36(2):415–423PubMedCrossRef

25.

Fierens J, Wolthuis AM, Penninckx F, D’Hoore A (2012) Enhanced recovery after surgery (ERAS) protocol: prospective study of outcome in colorectal surgery. Acta Chir Belg 112(5):355–358PubMed

26.

Noblett SE, Horgan AF (2007) A prospective case-matched comparison of clinical and financial outcomes of open versus laparoscopic colorectal resection. Surg Endosc 21(3):404–408PubMedCrossRef

27.

Dowson HM, Huang A, Soon Y, Gage H, Lovell DP, Rockall TA (2007) Systematic review of the costs of laparoscopic colorectal surgery. Dis Colon Rectum 50(6):908–919PubMedCrossRef

28.

Hernandez RA, de Verteuil RM, Fraser CM, Vale LD (2008) Systematic review of economic evaluations of laparoscopic surgery for colorectal cancer. Colorectal Dis 10(9):859–868PubMed

29.

Shabbir A, Roslani AC, Wong KS, Tsang CB, Wong HB, Cheong WK (2009) Is laparoscopic colectomy as cost beneficial as open colectomy? ANZ J Surg 79(4):265–270PubMedCrossRef

30.

Ridgway PF, Boyle E, Keane FB, Neary P (2007) Laparoscopic colectomy is cheaper than conventional open resection. Colorectal Dis 9(9):819–824PubMedCrossRef

31.

Aly OE, Quayyum Z (2012) Has laparoscopic colorectal surgery become more cost-effective over time? Int J Colorectal Dis 27(7):855–860PubMedCrossRef

32.

Senagore AJ, Duepree HJ, Delaney CP, Dissanaike S, Brady KM, Fazio VW (2002) Cost structure of laparoscopic and open sigmoid colectomy for diverticular disease: similarities and differences. Dis Colon Rectum 45(4):485–490PubMedCrossRef

33.

Janson M, Bjorholt I, Carlsson P, Haglind E, Henriksson M, Lindholm E, Anderberg B (2004) Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer. Br J Surg 91(4):409–417PubMedCrossRef

34.

King PM, Blazeby JM, Ewings P, Franks PJ, Longman RJ, Kendrick AH, Kipling RM, Kennedy RH (2006) Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme. Br J Surg 93(3):300–308PubMedCrossRef

35.

Senagore AJ, Madbouly KM, Fazio VW, Duepree HJ, Brady KM, Delaney CP (2003) Advantages of laparoscopic colectomy in older patients. Arch Surg 138(3):252–256PubMedCrossRef

36.

Senagore AJ, Brannigan A, Kiran RP, Brady K, Delaney CP (2005) Diagnosis-related group assignment in laparoscopic and open colectomy: financial implications for payer and provider. Dis Colon Rectum 48(5):1016–1020PubMedCrossRef

37.

Kang CY, Chaudhry OO, Halabi WJ, Nguyen V, Carmichael JC, Stamos MJ, Mills S (2012) Outcomes of laparoscopic colorectal surgery: data from the Nationwide Inpatient Sample 2009. Am J Surg 204(6):952–957PubMedCrossRef

38.

Mutch MG (2006) Laparoscopic colectomy in the elderly: when is too old? Clin Colon Rectal Surg 19(1):33–39PubMedCrossRef

Title: Optimizing cost and short-term outcomes for elderly patients in laparoscopic colonic surgery
Authors: Deborah S. Keller
Justin K. Lawrence
Tamar Nobel
Conor P. Delaney
Publication date: 01-12-2013
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 12/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-3088-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Optimizing cost and short-term outcomes for elderly patients in laparoscopic colonic surgery

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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