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More patients electing surgery for nonmalignant colorectal polyps
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Patients with nonmalignant colorectal polyps are undergoing invasive surgery at a significantly increasing rate over the past 14 years, according to research published in Gastroenterology.
Anne F. Peery, MD, MSCR , of the division of gastroenterology at the University of North Carolina School of Medicine, and colleagues called the increase in surgeries “concerning,” because the practice runs counter to the current literature that has established endoscopic resection as the preferred management of nonmalignant colorectal polyps.
“With advances in endoscopic mucosal resection, this practice should be changing,” the investigators wrote. “Compared with surgical resection, endoscopic resection is associated with a reduced risk of adverse events and is more cost-effective.”
Peery and colleagues analyzed data from the Healthcare Cost and Utilization Project National Inpatient Sample on patients who underwent elective colectomy or proctectomy who had a diagnosis of either nonmalignant colorectal polyp or colorectal cancer (n = 1,230,458) between 2000 and 2014.
Patients with nonmalignant colorectal polyps accounted for 25% of the surgeries (n = 304,578).
The incidence rate for these surgeries increased from 5.9 per 100,00 adults in 2000 to 9.4 per 100,000 in 2014, a difference of 3.56 (95% CI, 3.4–3.72). Over the same period, incidence of surgery for colorectal cancer decreased from 31.5 to 24.7 per 100,000, a difference of 6.8 (95% CI, –7.11 to –6.49).
Endoscopic resection is recommended for management of nonmalignant colorectal polyps because evidence has shown it to be more cost-effective and associated with a lower risk for adverse events. According to the researchers, 14% of patients who undergo surgery for nonmalignant colorectal polyps will have at least one major, short-term postoperative event, such as the need for ostomy, readmission or reoperation.
Peery and colleagues said the increase in surgery incidence could be due to several factors, including low reimbursement for endoscopic resection or failure to implement established guidelines. However, they said more research is needed to determine why patients are opting for surgery.
“Understanding volume and trends in surgery for nonmalignant colorectal polyps in the United States can increase awareness of how nonmalignant colorectal polyps are managed and better identify barriers to endoscopic management,” they wrote. – by Alex Young
Disclosures : The authors reported no relevant financial disclosures.
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