Surgery for Nonmalignant Colorectal Polyps: Not Good Medicine

Endoscopic polypectomy is feasible for the great majority of colorectal polyps. However, rates of surgical colorectal resections for nonmalignant polyps have been increasing in the U.S. (NEJM JW Gastroenterol Mar 2018 and Gastroenterology 2018; 154:1352).

To better assess outcomes after surgical resection for nonmalignant colorectal polyps, investigators conducted a retrospective analysis involving over 262,000 patients in the National Inpatient Sample database who underwent the procedure between 2005 and 2014.

Results were as follows:

• Overall in-hospital mortality was 0.8% and was higher with open versus laparoscopic resections (1.1% vs. 0.4%).

• Mortality increased progressively with age, from 0.2% in patients 50 to 59 years of age to 2.5% in patients ≥80 years of age.

• In-hospital adverse events occurred in 25.3% of patients and were most frequently gastrointestinal.

• While mortality rates remained stable over time, adverse events decreased after 2008.

• The factors significantly associated with mortality were open surgical technique, older age, black race, Medicaid insurance, and comorbidity burden.

• The New England and mid-Atlantic regions had the lowest rates of adverse events (about 23%).

• The mean length of hospital stay was 6.3 days, and the mean cost of hospitalization was about $50,000.

• In-hospital deaths and adverse events were associated with significant increases in length of stay and cost.