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

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.