Cargando…

Decreasing rates of colectomy for benign neoplasms: A nationwide analysis

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 c...

Descripción completa

Detalles Bibliográficos
Autores principales: Sakowitz, Sara, Bakhtiyar, Syed Shahyan, Mallick, Saad, Khoraminejad, Baran, Olmedo, Manuel, Croman, Millicent, Benharash, Peyman, Lee, Hanjoo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10599571/
https://www.ncbi.nlm.nih.gov/pubmed/37878628
http://dx.doi.org/10.1371/journal.pone.0293389
_version_ 1785125793718861824
author Sakowitz, Sara
Bakhtiyar, Syed Shahyan
Mallick, Saad
Khoraminejad, Baran
Olmedo, Manuel
Croman, Millicent
Benharash, Peyman
Lee, Hanjoo
author_facet Sakowitz, Sara
Bakhtiyar, Syed Shahyan
Mallick, Saad
Khoraminejad, Baran
Olmedo, Manuel
Croman, Millicent
Benharash, Peyman
Lee, Hanjoo
author_sort Sakowitz, Sara
collection PubMed
description 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.
format Online
Article
Text
id pubmed-10599571
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-105995712023-10-26 Decreasing rates of colectomy for benign neoplasms: A nationwide analysis Sakowitz, Sara Bakhtiyar, Syed Shahyan Mallick, Saad Khoraminejad, Baran Olmedo, Manuel Croman, Millicent Benharash, Peyman Lee, Hanjoo PLoS One Research Article 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. Public Library of Science 2023-10-25 /pmc/articles/PMC10599571/ /pubmed/37878628 http://dx.doi.org/10.1371/journal.pone.0293389 Text en © 2023 Sakowitz et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Sakowitz, Sara
Bakhtiyar, Syed Shahyan
Mallick, Saad
Khoraminejad, Baran
Olmedo, Manuel
Croman, Millicent
Benharash, Peyman
Lee, Hanjoo
Decreasing rates of colectomy for benign neoplasms: A nationwide analysis
title Decreasing rates of colectomy for benign neoplasms: A nationwide analysis
title_full Decreasing rates of colectomy for benign neoplasms: A nationwide analysis
title_fullStr Decreasing rates of colectomy for benign neoplasms: A nationwide analysis
title_full_unstemmed Decreasing rates of colectomy for benign neoplasms: A nationwide analysis
title_short Decreasing rates of colectomy for benign neoplasms: A nationwide analysis
title_sort decreasing rates of colectomy for benign neoplasms: a nationwide analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10599571/
https://www.ncbi.nlm.nih.gov/pubmed/37878628
http://dx.doi.org/10.1371/journal.pone.0293389
work_keys_str_mv AT sakowitzsara decreasingratesofcolectomyforbenignneoplasmsanationwideanalysis
AT bakhtiyarsyedshahyan decreasingratesofcolectomyforbenignneoplasmsanationwideanalysis
AT mallicksaad decreasingratesofcolectomyforbenignneoplasmsanationwideanalysis
AT khoraminejadbaran decreasingratesofcolectomyforbenignneoplasmsanationwideanalysis
AT olmedomanuel decreasingratesofcolectomyforbenignneoplasmsanationwideanalysis
AT cromanmillicent decreasingratesofcolectomyforbenignneoplasmsanationwideanalysis
AT benharashpeyman decreasingratesofcolectomyforbenignneoplasmsanationwideanalysis
AT leehanjoo decreasingratesofcolectomyforbenignneoplasmsanationwideanalysis