SAN DIEGO – Within the setting of academic medical centers, bariatric surgery is the most common elective general surgical operation and it has the highest use of laparoscopy.
In addition, the in-hospital mortality rate of laparoscopic bariatric surgery is now comparable to those of laparoscopic appendectomy and antireflux surgery, and is currently lower than that of laparoscopic cholecystectomy.
Those are main findings from an analysis of data from the University HealthSystem Consortium database, which contains data from 114 academic centers and 250 major teaching affiliates in the United States.
"Laparoscopy has revolutionized the performance of most intra-abdominal operations [and] is now widely utilized in many different types of general surgical operations," Brian Nguyen, a research student at the University of California, Irvine, said at the annual meeting of the American Society for Metabolic and Bariatric Surgery.
He and his associates searched the University HealthSystem database to determine the rate of laparoscopy use in seven common elective general surgical operations performed between Oct. 1, 2008, and March 31, 2012: antireflux surgery for gastroesophageal reflux disease (GERD) or hiatal hernia, cholecystectomy for chronic cholecystitis, bariatric surgery for morbid obesity, ventral hernia repair for incisional hernia, appendectomy for acute appendicitis, rectal resection for rectal cancer, and colectomy for colon cancer or diverticulitis. Secondary objectives were to determine the rate of conversion to open surgery, length of stay, overall complications, and in-hospital mortality.
The most common elective surgical procedure performed during the study period was bariatric surgery (53,958 cases), followed by colectomy (29,934 cases), ventral hernia repair (17,749 cases), antireflux surgery (13,918 cases), appendectomy (8,654 cases), cholecystectomy (8,512 cases), and rectal resection (4,729). Bariatric surgery also led the way with the highest rate of laparoscopy use (94%), followed by antireflux surgery (83%), appendectomy (79%), cholecystectomy (77%), colectomy (52%), ventral hernia repair (28%), and rectal resection (18%).
As for perioperative outcomes (see table), Mr. Nguyen reported that patients who underwent bariatric surgery had the lowest conversion rate to open procedures (0.89%). The overall complication rate of 2.2% and the in-hospital mortality rate of 0.06% associated with bariatric surgery were lower only in appendectomy, which had rates of 0.8% and 0.01%, respectively. The mean length of stay for bariatric surgery patients was 2.26 days, which was higher than that for appendectomy and cholecystectomy patients (a mean of 1.66 and 2.03 days, respectively), but lower than that for antireflux surgery (a mean of 2.80 days).
Mr. Nguyen acknowledged that the study was limited by the fact that it represented only inpatients at academic medical centers and affiliated hospitals.
He said that he had no relevant financial conflicts to disclose.