Effects of laparoscopic surgery on survival, quality of care and utilization in patients with colon cancer: a population-based study

<p><b>Objective:</b> Laparoscopy is a safe and effective treatment for colon cancer. However, its effects on short- and long-term health outcomes and medical utilization are not fully elucidated. This study aimed to compare short- and long-term utilization and health outcomes of colon cancer patients who underwent either laparoscopic or open surgery in a population-based cohort.</p> <p><b>Methods:</b> This study was conducted by linking data from Taiwan Cancer Registry, National Health Insurance claims and Death Registry. Patients aged 18 and older with colon cancer between 2009 and 2012 were included in the study. Propensity score matching was used to minimize selection bias between laparoscopic and open surgery groups. Cox proportional hazard regression and generalized linear mixed logistic regression were used to test hypotheses.</p> <p><b>Results:</b> Among the 11,269 colon cancer patients who underwent colectomy, 3236 (28.72%) received laparoscopy and 8033 (71.28%) underwent open surgery. Patients who received laparoscopic surgery had better overall survival (HR = 0.82; 95% CI: 0.70–0.97). These patients also had lower 30 day mortality (0.44% vs. 0.91%), lower 1 year mortality (2.83% vs. 4.68%), lower overall occurrence of complications (6.16% vs. 8.77%), shorter mean length of stay (12.53 vs. 14.93 days) and lower cost for index hospitalization (US$4325.34 vs. US$4453.90). No significant differences were observed in medical utilization over a period of 365 days after the surgery.</p> <p><b>Conclusions:</b> Our results demonstrate that, in both the short- and long-term post-operation periods, laparoscopic surgery reduced the likelihood of postoperative complications, 30 day, and 1 year mortality while being no more expensive than open surgery for colon cancer.</p

Comparison the settings of the traditional general medicine and hospitalist staffing on weekdays and weekends.

<p>Comparison the settings of the traditional general medicine and hospitalist staffing on weekdays and weekends.</p

Study outcomes of pre-intervention, post-intervention and three-year follow-up cohort showed improved weekend versus weekday admission outcomes after intervention.

<p>Study outcomes of pre-intervention, post-intervention and three-year follow-up cohort showed improved weekend versus weekday admission outcomes after intervention.</p

Clinical characteristics and outcomes of the three-year follow-up cohort with comparisons between weekday and weekend admissions.

<p>Clinical characteristics and outcomes of the three-year follow-up cohort with comparisons between weekday and weekend admissions.</p

Characteristics and outcomes of the pre- and post-intervention cohort in caring for weekday and weekend admissions.

<p>Characteristics and outcomes of the pre- and post-intervention cohort in caring for weekday and weekend admissions.</p

Results of propensity score matching for weekday and weekend admissions in the hospitalist-care cohort.

<p>Results of propensity score matching for weekday and weekend admissions in the hospitalist-care cohort.</p

Flow chart of patient enrollment.

<p>*Patient admitted in fixed region of the hospitalist-care ward.</p

Related staffing costs in managing hot-line medical counseling.

<p>All costs were at an exchange rate of US$1.00 to 29.37 NT$ as of 1st October 2012.</p>*<p>Cost/hr was calculated using average monthly payment divided by 160 formal work-hours per month. Payment information was based on the time period from January to June 2012.</p

Curves plotted using the Kaplan-Meier method for (A) patients with post-discharge medical counseling (PDMC) alone or (B) with red-flag sign (RFS), according to the levels of Barthel index (BI) score.

<p>Curves plotted using the Kaplan-Meier method for (A) patients with post-discharge medical counseling (PDMC) alone or (B) with red-flag sign (RFS), according to the levels of Barthel index (BI) score.</p

Criteria of red flag signs for each specific indicator.

<p>This table is modified from our previous study <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0064274#pone.0064274-Shu2" target="_blank">[13]</a> with permission from publisher of BioMed Central.</p>*<p>Measured by the Medical Research Council dyspnea scale <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0064274#pone.0064274-Bestall1" target="_blank">[28]</a>.</p>#<p>Measured by a grading system developed for cancer treatment <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0064274#pone.0064274-Trotti1" target="_blank">[29]</a>.</p>†<p>Measured by the Numerical Rating Scale <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0064274#pone.0064274-Stinson1" target="_blank">[30]</a>.</p>‡<p>Measured by the longest length of the lesion.</p