Decreasing rates of colectomy for benign neoplasms: A nationwide analysis.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2023
2023
Historique:
received:
16
05
2023
accepted:
25
09
2023
medline:
27
10
2023
pubmed:
25
10
2023
entrez:
25
10
2023
Statut:
epublish
Résumé
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. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 37878628
doi: 10.1371/journal.pone.0293389
pii: PONE-D-23-14859
pmc: PMC10599571
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0293389Informations de copyright
Copyright: © 2023 Sakowitz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Cancer. 2004 May 15;100(10):2093-103
pubmed: 15139050
Gastroenterology. 2018 Apr;154(5):1352-1360.e3
pubmed: 29317277
Dig Liver Dis. 2014 Aug;46(8):701-5
pubmed: 24731727
Endoscopy. 2006 Feb;38(2):170-4
pubmed: 16479425
Gastrointest Endosc. 2015 Mar;81(3):583-95
pubmed: 25592748
Endoscopy. 2016 Mar;48(3):263-70
pubmed: 26340603
World J Gastroenterol. 2019 Jan 21;25(3):300-307
pubmed: 30686899
J Surg Res. 2018 Nov;231:421-427
pubmed: 30278962
Am J Gastroenterol. 2014 Sep;109(9):1312-24
pubmed: 25001256
N Engl J Med. 2012 Feb 23;366(8):697-706
pubmed: 22356323
CA Cancer J Clin. 2020 May;70(3):145-164
pubmed: 32133645
Gut. 2016 May;65(5):806-20
pubmed: 25681402
Gastroenterology. 2011 Jun;140(7):1909-18
pubmed: 21392504
Am J Gastroenterol. 2020 Dec;115(12):1998-2006
pubmed: 32833733
World J Gastrointest Endosc. 2018 Oct 16;10(10):225-238
pubmed: 30364783
Frontline Gastroenterol. 2020 Feb 25;12(2):95-101
pubmed: 33613939
Clin Gastroenterol Hepatol. 2016 Feb;14(2):271-8.e1-2
pubmed: 26364679
Surgery. 2019 Nov;166(5):778-784
pubmed: 31307773
World J Gastroenterol. 2015 Oct 28;21(40):11209-20
pubmed: 26523097
Stat Med. 1985 Jan-Mar;4(1):87-90
pubmed: 3992076
Crit Rev Oncol Hematol. 2016 Aug;104:138-55
pubmed: 27370173
J Surg Res. 2012 Dec;178(2):708-14
pubmed: 22940030
Clin Gastroenterol Hepatol. 2019 Jan;17(1):16-25.e1
pubmed: 30077787
Surg Endosc. 2011 Jan;25(1):255-60
pubmed: 20559661
Ethn Dis. 2006 Winter;16(1):228-33
pubmed: 16599375
Colorectal Dis. 2010 Oct;12(10):958-64
pubmed: 19604288
J Gastroenterol Hepatol. 2010 Nov;25(11):1747-53
pubmed: 21039836
Curr Gastroenterol Rep. 2020 Jun 3;22(7):32
pubmed: 32494878
Clin Gastroenterol Hepatol. 2016 Apr;14(4):568-74
pubmed: 26499926
Int J Colorectal Dis. 2009 Jun;24(6):711-23
pubmed: 19221766
Endoscopy. 2015 Aug;47(8):719-25
pubmed: 25763833
BMJ Open Gastroenterol. 2020 Feb 19;7(1):e000353
pubmed: 32128228
Cancer. 2004 Jan 15;100(2):418-24
pubmed: 14716780
Clin Transl Gastroenterol. 2022 May 01;13(5):e00477
pubmed: 35347095
Cancer. 2016 Aug 15;122(16):2479-86
pubmed: 27200481
Gastrointest Endosc. 2016 Jun;83(6):1248-57
pubmed: 26608129
Surg Endosc. 2010 Feb;24(2):343-52
pubmed: 19517168
Expert Rev Gastroenterol Hepatol. 2014 Feb;8(2):119-21
pubmed: 24308749
Gastrointest Endosc. 1992 May-Jun;38(3):303-9
pubmed: 1607080
Endoscopy. 2014 May;46(5):388-402
pubmed: 24671869
N Engl J Med. 2012 Feb 23;366(8):687-96
pubmed: 22356322
Cancer Epidemiol Biomarkers Prev. 2012 May;21(5):728-36
pubmed: 22514249
Clin Gastroenterol Hepatol. 2016 Feb;14(2):279-86.e1-2
pubmed: 26343183
Arch Surg. 2009 Jun;144(6):532-5
pubmed: 19528386
Int J Colorectal Dis. 2017 Dec;32(12):1711-1717
pubmed: 28884225
Med Care. 1998 Jan;36(1):8-27
pubmed: 9431328
VideoGIE. 2019 Jun 29;4(8):343-350
pubmed: 31388606