Implementation of laparoscopic colectomy with fast-track care in an academic medical center: benefits of a fully ascended learning curve and specialty expertise

Raul M. Bosio, Bryan M. Smith, Pablo Serrano Aybar, Anthony J. Senagore

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background: There are few data describing successful institutional "conversion" from open colectomy/standard care techniques to laparoscopic colectomy/fast-track care. Purpose: To assess the benefits of transitioning an institution from open to laparoscopic colectomy with fast-track care while avoiding a learning curve. Method: Twenty consecutive laparoscopic colorectal resections (LCRs) performed by a colorectal surgeon were compared with 20 matched open colorectal resections (OCRs) performed by general surgeons before the arrival of the colorectal surgeon. Results: Surgical procedures were as follows: sigmoidectomy: OCR 16 and LCR 11; right colectomy: OCR 3 and LCR 8; and total colectomy: OCR 1 and LCR 1. The mean operative time for sigmoidectomy was 250 and 109 minutes for OCR and LCR, respectively, and for right colectomy 181 and 97 minutes for OCR and LCR, respectively (P <.001). Morbidity was OCR 45% versus LCR 25%. There was no mortality. LCR showed significantly lower length of stay and direct cost (3.6 vs. 8.3 days; $4,993 vs. $11,383; both P <.001). Conclusions: The data clearly show an institutional benefit for the implementation of specialty-based advanced laparoscopic procedures.

Original languageEnglish (US)
Pages (from-to)413-416
Number of pages4
JournalAmerican Journal of Surgery
Volume193
Issue number3
DOIs
StatePublished - Mar 2007
Externally publishedYes

Fingerprint

Learning Curve
Colectomy
Operative Time
Length of Stay
Morbidity
Costs and Cost Analysis
Mortality
Surgeons

Keywords

  • Cost analysis
  • Laparoscopic colectomy
  • Length of stay

ASJC Scopus subject areas

  • Surgery

Cite this

Implementation of laparoscopic colectomy with fast-track care in an academic medical center : benefits of a fully ascended learning curve and specialty expertise. / Bosio, Raul M.; Smith, Bryan M.; Aybar, Pablo Serrano; Senagore, Anthony J.

In: American Journal of Surgery, Vol. 193, No. 3, 03.2007, p. 413-416.

Research output: Contribution to journalArticle

@article{2fa3043ab81c4f30960311c01b430b98,
title = "Implementation of laparoscopic colectomy with fast-track care in an academic medical center: benefits of a fully ascended learning curve and specialty expertise",
abstract = "Background: There are few data describing successful institutional {"}conversion{"} from open colectomy/standard care techniques to laparoscopic colectomy/fast-track care. Purpose: To assess the benefits of transitioning an institution from open to laparoscopic colectomy with fast-track care while avoiding a learning curve. Method: Twenty consecutive laparoscopic colorectal resections (LCRs) performed by a colorectal surgeon were compared with 20 matched open colorectal resections (OCRs) performed by general surgeons before the arrival of the colorectal surgeon. Results: Surgical procedures were as follows: sigmoidectomy: OCR 16 and LCR 11; right colectomy: OCR 3 and LCR 8; and total colectomy: OCR 1 and LCR 1. The mean operative time for sigmoidectomy was 250 and 109 minutes for OCR and LCR, respectively, and for right colectomy 181 and 97 minutes for OCR and LCR, respectively (P <.001). Morbidity was OCR 45{\%} versus LCR 25{\%}. There was no mortality. LCR showed significantly lower length of stay and direct cost (3.6 vs. 8.3 days; $4,993 vs. $11,383; both P <.001). Conclusions: The data clearly show an institutional benefit for the implementation of specialty-based advanced laparoscopic procedures.",
keywords = "Cost analysis, Laparoscopic colectomy, Length of stay",
author = "Bosio, {Raul M.} and Smith, {Bryan M.} and Aybar, {Pablo Serrano} and Senagore, {Anthony J.}",
year = "2007",
month = "3",
doi = "10.1016/j.amjsurg.2006.09.019",
language = "English (US)",
volume = "193",
pages = "413--416",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Implementation of laparoscopic colectomy with fast-track care in an academic medical center

T2 - benefits of a fully ascended learning curve and specialty expertise

AU - Bosio, Raul M.

AU - Smith, Bryan M.

AU - Aybar, Pablo Serrano

AU - Senagore, Anthony J.

PY - 2007/3

Y1 - 2007/3

N2 - Background: There are few data describing successful institutional "conversion" from open colectomy/standard care techniques to laparoscopic colectomy/fast-track care. Purpose: To assess the benefits of transitioning an institution from open to laparoscopic colectomy with fast-track care while avoiding a learning curve. Method: Twenty consecutive laparoscopic colorectal resections (LCRs) performed by a colorectal surgeon were compared with 20 matched open colorectal resections (OCRs) performed by general surgeons before the arrival of the colorectal surgeon. Results: Surgical procedures were as follows: sigmoidectomy: OCR 16 and LCR 11; right colectomy: OCR 3 and LCR 8; and total colectomy: OCR 1 and LCR 1. The mean operative time for sigmoidectomy was 250 and 109 minutes for OCR and LCR, respectively, and for right colectomy 181 and 97 minutes for OCR and LCR, respectively (P <.001). Morbidity was OCR 45% versus LCR 25%. There was no mortality. LCR showed significantly lower length of stay and direct cost (3.6 vs. 8.3 days; $4,993 vs. $11,383; both P <.001). Conclusions: The data clearly show an institutional benefit for the implementation of specialty-based advanced laparoscopic procedures.

AB - Background: There are few data describing successful institutional "conversion" from open colectomy/standard care techniques to laparoscopic colectomy/fast-track care. Purpose: To assess the benefits of transitioning an institution from open to laparoscopic colectomy with fast-track care while avoiding a learning curve. Method: Twenty consecutive laparoscopic colorectal resections (LCRs) performed by a colorectal surgeon were compared with 20 matched open colorectal resections (OCRs) performed by general surgeons before the arrival of the colorectal surgeon. Results: Surgical procedures were as follows: sigmoidectomy: OCR 16 and LCR 11; right colectomy: OCR 3 and LCR 8; and total colectomy: OCR 1 and LCR 1. The mean operative time for sigmoidectomy was 250 and 109 minutes for OCR and LCR, respectively, and for right colectomy 181 and 97 minutes for OCR and LCR, respectively (P <.001). Morbidity was OCR 45% versus LCR 25%. There was no mortality. LCR showed significantly lower length of stay and direct cost (3.6 vs. 8.3 days; $4,993 vs. $11,383; both P <.001). Conclusions: The data clearly show an institutional benefit for the implementation of specialty-based advanced laparoscopic procedures.

KW - Cost analysis

KW - Laparoscopic colectomy

KW - Length of stay

UR - http://www.scopus.com/inward/record.url?scp=33847021350&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33847021350&partnerID=8YFLogxK

U2 - 10.1016/j.amjsurg.2006.09.019

DO - 10.1016/j.amjsurg.2006.09.019

M3 - Article

C2 - 17320546

AN - SCOPUS:33847021350

VL - 193

SP - 413

EP - 416

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 3

ER -