Laparoscopic techniques have been introduced about 30 years ago and were expected to have a disruptive impact on surgery. Scientific literature and community promote their use since supporting evidence has been produced in terms of both clinical outcomes and organisational aspects. However, the Italian analysis shows an unexpected scenario.
The report presents the analysis of the last available yearly dataset from the hospital discharge records at national level, 2014. From this, the volume of the procedures of interest were extracted by using the keywords “laparoscopy” or “arthroscopy” within the description of the primary procedure and the ICD-9-CM code “54.21 - Laparoscopy” as a secondary procedure. Procedures coded with “00.39 Other computer assisted surgery” and counting at least 30 cases per year were also included to take in robotic surgery as well.
Nineteen procedures were described, 38.5% (n=143,896) of the total volume of procedures identified (n=373,958), and listed under 3 areas: i) general surgery; ii) urology; iii) gynaecology. Laparoscopic surgery appears to be less used in genecology than in general surgery and urology.
Mean length of hospital stay was chosen as performance indicator and showed that the laparoscopic approach was linked to a reduced stay compared to open surgery for 16 of the 19 procedures observed. Mean hospital stay was reduced up to 66% (8.4 days) for cholecystectomy (codes 51.22 and 51.23) while for other procedures, like other and open repair of indirect inguinal hernia with graft or prosthesis (code 53.04), and repair of umbilical hernia with prosthesis (code 53.41), no reductions were observed.
As a case-of-study, the report presented a detailed analysis of the laparoscopic procedures performed on the colon by comparing data for four specific procedures, performed in laparoscopy and laparotomy, with different rates across the Italian Regions. Northern Regions shows higher rates of use of laparoscopic approaches than other Regions in the South.
The authors listed the following limits of the project:
- Analysis of more recent data was not possible being 2014 the last available dataset of the hospital discharge records from the Ministry of Health.
- The ICD-9-CM codes may “hide” all those procedures that do not have a specific code and an update of the coding is necessary to perform a more accurate analysis.
- Local elements linked to epidemiology aspects, presence of centres of excellence, and interregional migration of patients have not been included.
See full report in Italian here.
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