Surgical vs. Endoscopic Resection of Large, Nonmalignant Colorectal Polyps

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To determine nationally representative estimates and to identify predictors of in-hospital mortality and morbidity after surgery for nonmalignant colorectal polyps, data was analyzed from a national inpatient sample for 2005 to 2014. All discharges for adult patients undergoing surgery for nonmalignant colorectal polyps were identified. Rates of in-hospital mortality and postoperative wounds, infections, urinary, pulmonary, gastrointestinal or cardiovascular adverse effects were calculated. Multivariable logistic regression using survey-weighted data was used to identify variables associated with postoperative mortality and morbidity. An estimated 262,843 surgeries for nonmalignant colorectal polyps were analyzed. In-hospital mortality was 0.8% and morbidity was 25.3%. Postoperative mortality was associated with open surgical technique (vs. laparoscopic), older age, black race, Medicaid use and burden of comorbidities. Female sex and private insurance were associated with lower risk. Patients developing a postoperative adverse event had a 106% increase in mean hospital length of stay and 91% increase in mean hospitalization cost. It was concluded that surgery for nonmalignant colorectal polyps is associated with almost 1% mortality and common morbidity. Risk vs. benefit discussion for clinicians and patients was indicated, and although confounding by patient selection, cannot be excluded, the risk associated with surgery support consideration of endoscopic resection as a potentially less invasive therapeutic option.

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