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Trends in laparoscopic colorectal surgery over time from 2005-2014 using the NSQIP database.

Catherine H Davis1, Beverly A Shirkey2, Linda W Moore3

  • 1Department of Surgery, Houston Methodist Hospital, Houston, Texas; Department of Epidemiology, The University of Texas School of Public Health, Houston, Texas.

The Journal of Surgical Research
|February 14, 2018
PubMed
Summary

Minimally invasive laparoscopic colorectal surgery adoption increased significantly over a decade, now including higher-risk patients. This trend indicates wider acceptance and application of advanced surgical techniques in colorectal procedures.

Keywords:
Colorectal surgeryLaparoscopyMinimally invasive surgeryNSQIP

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Area of Science:

  • Colorectal Surgery
  • Minimally Invasive Surgery
  • Surgical Technology Adoption

Background:

  • Laparoscopy, initially developed in gynecology, was adopted by general surgery in the late 1980s and subsequently in colorectal surgery for benign and malignant conditions.
  • Formal laparoscopic training is now standard in surgical residencies, yet apprehension regarding widespread minimally invasive technique adoption persists among some surgeons.
  • While increased laparoscopy use in colorectal surgery is expected, its application in higher-risk or acutely ill patients remains uncertain.

Purpose of the Study:

  • To analyze the trends in laparoscopic colorectal surgery adoption over a 10-year period.
  • To determine if laparoscopic techniques are being applied to more complex or higher-risk patient populations.
  • To assess the impact of patient factors like age, BMI, and ASA classification on laparoscopy utilization.

Main Methods:

  • Utilized the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database (2005-2014).
  • Identified and categorized colorectal procedures as open or laparoscopic using Current Procedural Terminology (CPT) codes.
  • Analyzed trends by year and stratified data by age, body mass index (BMI), American Society of Anesthesiology (ASA) classification, and emergency case status.

Main Results:

  • The proportion of laparoscopic colorectal surgeries rose from 22.7% in 2005 to 49.8% in 2014.
  • Laparoscopy use increased across all age groups, BMI categories (including obese), and most ASA classes (3-4).
  • The percentage of emergency laparoscopic colorectal surgeries doubled from 5.5% to 11.5% during the study period.

Conclusions:

  • Laparoscopic colorectal surgery has seen gradual but consistent adoption over the past decade.
  • The use of minimally invasive techniques has expanded to include elderly patients, those with higher BMIs, and those with higher ASA classifications.
  • These findings suggest that minimally invasive colorectal surgery is increasingly being performed on more complex and higher-risk patients, indicating broad adoption.