Decreasing rates of colectomy for benign neoplasms: A nationwide analysis

Abstract

Background Despite advances in endoscopic techniques for management of benign colonic neoplasms, a rise in rates of surgical treatment has been reported. We used a nationally representative cohort to characterize temporal trends, patient characteristics, and outcomes associated with colectomy for colonic neoplasms. Methods All patients undergoing elective partial colectomy for benign or malignant colonic neoplasms were identified using the 2012–2019 National Inpatient Sample. Those presenting with inflammatory bowel disease, or experiencing intestinal perforation were excluded. Patients with benign neoplasms were classified as the Benign cohort (others: Malignant). Trends, characteristics, and outcomes were assessed between groups. Results Of 569,280 colectomy procedures included for analysis, 153,435 (27.0%) were performed for benign lesions. The proportion of Benign operations decreased from 28.6% in 2012 to 23.7% in 2019 (P for trend<0.001). While overall national incidence of colectomy for benign neoplasms decreased from 2012 to 2019 (IRD -1.19, 95%CI -1.20- -1.19), Black patients demonstrated an incremental increase (IRD +0.04, 95%CI +0.02–0.06). On average, Benign was younger (66 [57–72] vs 68 years [58–77], P<0.001), and demonstrated a lower Elixhauser comorbidity index (2 [1–3] vs 3 [2–4], P<0.001), relative to Malignancy. Following adjustment, Benign demonstrated lower odds of in-hospital mortality (AOR 0.61, 95%CI 0.50–0.74; P<0.001), stoma creation (AOR 0.46, 95%CI 0.43–0.50; P<0.001), and infectious complications (AOR 0.68, 95%CI 0.63–0.73; P<0.001). Conclusions The present national study identifies a decrease in colectomy for benign polyps from 2012–2019. Future investigations should identify patients who would most benefit from surgical resection and address persistent inequities in access to screening and treatment for colonic neoplasms.