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首页> 外文期刊>Surgical Endoscopy >Laparoscopic colectomy significantly decreases length of stay compared with open operation.
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Laparoscopic colectomy significantly decreases length of stay compared with open operation.

机译：与开放手术相比，腹腔镜结肠切除术显着缩短了住院时间。

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INTRODUCTION: Current literature tends not to adjust for biases in patient selection attributable to comorbidities that could provide alternate explanations for length of stay differences in laparoscopic versus open colectomy. We hypothesized that utilizing the National Surgical Quality Improvement Program (NSQIP) dataset and acuity adjustment methods would demonstrate an independent improvement in length of stay for laparoscopic colectomy. METHODS: We used CPT coding to select all colectomies in NSQIP public use files from 2005-2009. Outlier status for surgical length of stay (SLOS) was defined as >75th percentile. Logistic regression analysis was used to predict this outlier status and linear regression to directly predict SLOS. Acuity adjustment was performed by using the most prevalent variables from multiple NSQIP annual reports. This work was done under the approval of our institutional review board and the data use agreement of the American College of Surgeons. Data were analyzed by using SPSS((R)). RESULTS: A total of 45,645 colectomies were reviewed, of which 12,455 (27.3%) were laparoscopic. The 75th percentile for SLOS was 11 days. This implied that 9,249 (27.9%) of the open colectomies were outliers, whereas only 1,152 (9.2%) of laparoscopic colectomies were outliers (p < 0.001). When optimizing a simple linear regression to predict SLOS, using common acuity adjustors (i.e., age, functional status, wound category, etc.), the variable marking open procedures consistently had a coefficient of 1.8, implying that open procedures increased SLOS by 1.8 days (p < 0.001). Utilizing logistic regression to predict outlier status, open colectomies were associated with an odds ratio of 3.79 for outlier status (p < 0.001), thus implying an independent effect on SLOS. CONCLUSIONS: These results indicate that laparoscopic colectomy independently decreases SLOS compared with open colectomy. This study is unique in using statistical methods to control for selection bias of patients who might be more surgically fit.
机译：简介：目前的文献倾向于不对合并症引起的患者选择偏倚进行调整，这可能会为腹腔镜与开放式结肠切除术的住院天数差异提供另一种解释。我们假设利用国家手术质量改善计划（NSQIP）数据集和敏锐度调整方法将证明腹腔镜结肠切除术的住院时间有独立的改善。方法：我们使用CPT编码从2005-2009年的NSQIP公共用途文件中选择所有colectomies。手术住院时间（SLOS）的异常状态定义为> 75％。 Logistic回归分析用于预测这种异常状态，而线性回归则用于直接预测SLOS。通过使用多个NSQIP年度报告中最普遍的变量来进行视力调整。这项工作是在我们机构审查委员会的批准下以及美国外科医生学院的数据使用协议下完成的。数据通过使用SPSS（R）进行分析。结果：共检查了45,645例Colectomies，其中有12,455例（27.3％）为腹腔镜检查。 SLOS的第75个百分位数是11天。这意味着有9249个（27.9％）的开放式Colectomies是异常值，而腹腔镜Colectomies的仅有1152个（9.2％）是异常值（p <0.001）。当使用常见的敏锐度调节器（即年龄，功能状态，伤口类别等）优化简单的线性回归以预测SLOS时，标记开放手术的变量始终具有1.8的系数，这意味着开放手术使SLOS增加了1.8天（p <0.001）。利用逻辑回归预测离群值状态，开放式colectomies与离群值状态的比值比为3.79（p <0.001），因此暗示对SLOS具有独立作用。结论：这些结果表明，与开放式结肠切除术相比，腹腔镜结肠切除术可独立降低SLOS。该研究的独特之处在于使用统计学方法来控制可能更适合手术的患者的选择偏倚。

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