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

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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.

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References

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

    PubMed  CAS  Google Scholar 

  2. 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):155–157

    Article  PubMed  CAS  Google Scholar 

  3. 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):326–332

    Article  PubMed  CAS  Google Scholar 

  4. 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):401–405

    Article  PubMed  CAS  Google Scholar 

  5. 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):1031–1033

    Article  PubMed  CAS  Google Scholar 

  6. 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):22–26

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  9. 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):2692–2698

    Article  PubMed  Google Scholar 

  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):19–30

    Article  PubMed  Google Scholar 

  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):830–840

    Article  PubMed  Google Scholar 

  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):67–72

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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 355–356

    Article  PubMed  Google Scholar 

  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):333–337

    Article  PubMed  CAS  Google Scholar 

  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):176–182

    Article  PubMed  CAS  Google Scholar 

  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):865–877

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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):776–780

    Article  PubMed  CAS  Google Scholar 

  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):1397–1400

    Article  PubMed  CAS  Google Scholar 

  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):296–300

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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):S8

    Article  PubMed  Google Scholar 

  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):415–423

    Article  PubMed  Google Scholar 

  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):355–358

    PubMed  CAS  Google Scholar 

  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):404–408

    Article  PubMed  CAS  Google Scholar 

  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):908–919

    Article  PubMed  Google Scholar 

  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):859–868

    PubMed  CAS  Google Scholar 

  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):265–270

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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):485–490

    Article  PubMed  Google Scholar 

  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):409–417

    Article  PubMed  CAS  Google Scholar 

  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):300–308

    Article  PubMed  CAS  Google Scholar 

  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):252–256

    Article  PubMed  Google Scholar 

  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):1016–1020

    Article  PubMed  Google Scholar 

  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):952–957

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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Acknowledgment

The authors received no funding or financial support for this study.

Disclosures

Ms. Nobel and Drs. Keller, Lawrence, and Delaney have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106-5047, USA

    Deborah S. Keller, Justin K. Lawrence & Conor P. Delaney

  2. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Tamar Nobel

Authors
  1. Deborah S. Keller
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  2. Justin K. Lawrence
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  3. Tamar Nobel
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  4. Conor P. Delaney
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Correspondence to Deborah S. Keller.

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Keller, D.S., Lawrence, J.K., Nobel, T. et al. Optimizing cost and short-term outcomes for elderly patients in laparoscopic colonic surgery. Surg Endosc 27, 4463–4468 (2013). https://doi.org/10.1007/s00464-013-3088-z

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  • DOI: https://doi.org/10.1007/s00464-013-3088-z

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