Laparoscopic colectomy compared with open colectomy for Crohn disease (CD) in pediatric patients is associated with shorter hospitalization and similar hospital costs, according to a study in the Journal of Pediatric Surgery.
Researchers used the Nationwide Readmissions Database (NRD) to compare outcomes of laparoscopic and open colectomy for CD. Eligible study participants were aged younger than 18 years and had a colectomy from 2010 to 2014. Researchers assessed comorbidities, operative procedures, and complications among patients with the procedures.
A total of 2833 patients with CD had a colectomy during the study period. Most study participants (87%) were aged 13 to 18 years, and 55% were male. Admission operations were elective for 55% of the cohort, and 86% of index operations were right hemicolectomies. The colectomy was laparoscopic in 58% of cases and open in 42%.
The patients had a readmission rate of 9% at 30 days and 18% overall. The most frequently occurring conditions at readmission were infections (23%), with intra-abdominal infections the most common (16%). Surgical site infections occurred in 9% of readmission cases.
Laparoscopic vs open colectomy was more commonly used in elective admissions (63% vs 56%, P <.001) and was less likely in patients with a Charlson Comorbidity Index (CCI) greater than 1 (9% vs 12%, P =.016). Laparoscopy was used more frequently by patients with private insurance (36% vs 25%), as well as by those in the highest income quartile (36% vs 15% in the lowest income quartile) (both P <.001).
The hospital length of stay was longer for the open colectomy group than for the laparoscopy group (8 days vs 6 days, P <.001), and the cost of index admission was similar in the 2 groups ($17,754 [$12,375-$30,625] vs $17,017 [$11,219-$27,336], respectively) (P =.104).
Readmission rates were comparable at 30 days and within 1 year, and no differences were observed in the rates of reoperation at readmission, intrabdominal infection, or bowel obstruction between the 2 techniques.
In a comparison of the lowest and highest quartiles of income, participants in the lowest quartile were less likely to have an elective admission (44% vs 59%) and more likely to have a high CCI (17% vs 11%), weight loss (15% vs 12%), and anemia (33% vs 18%), all P <.001.
Study limitations included the retrospective review of the NRD. Also, operative time, concurrent medical therapies, indication for surgery, and timing of index admission complications were not recorded in the database. Researchers noted that the lack of timelines could lead to measurement bias, and the NRD does not follow patients across years or across state lines if readmitted.
“In this study, laparoscopy was found to have better outcomes during index hospitalization and similar long-term outcomes,” the researchers wrote. “Disparities between low- and high-income households were seen in presentation and use of laparoscopy. Further efforts are needed to mitigate factors leading to disparate treatment of patient populations.”
Gilna GP, Saberi RA, O’Neil CF, et al. Disparities in utilization of laparoscopic colectomies in pediatric Crohn’s disease. J Pediatr Surg. 2022;57(6):1110-1114. doi:10.1016/j.jpedsurg.2022.01.030