National trends and outcomes for the surgical therapy of ileocolonic crohn's disease: A population-based analysis of laparoscopic vs. open approaches

Abstract

Purpose: The laparoscopic approach to Crohn's disease has demonstrated benefits in several small series. We sought to examine its use and outcomes on a national level. Methods: All admissions with a diagnosis of Crohn's disease requiring bowel resection were selected from the 2000-2004 Nationwide Inpatient Sample. Regression analyses were used to compare outcome measures and identify independent predictors of undergoing laparoscopy. Results: Of 396,911 patients admitted for Crohn's disease, 49,609 (12%) required surgical treatment. They were predominately Caucasian (64%), female (54%), and with ileocolic disease (72%). Most had private insurance (71%) and had surgery in urban hospitals (91%). Laparoscopic resection was performed in 2,826 cases (6%) and was associated with lower complications (8% vs. 16%), shorter length of stay (6 vs. 9 days), lower charges ($27,575 vs. $38,713), and mortality (0.2% vs. 0.9%, all P∈ <35 [odds ratio (OR)∈=∈2.4], female gender (OR∈=∈1.4), admission to a teaching hospital (OR∈=∈1.2), ileocecal location (OR∈=∈1.5), and lower disease stage (OR∈=∈1.1, all P∈ ∈0.05). Conclusions: A variety of patient- and system-related factors influence the utilization of laparoscopy in Crohn's disease. Laparoscopic resection is associated with excellent short-term outcomes compared to open surgery. © 2009 The Society for Surgery of the Alimentary Tract.