Temporal trends in colorectal resections for benign colorectal neoplasia: A retrospective cohort study of the ACS-NSQIP 2016-2022.

backgroundColorectal cancer (CRC) screening programmes in North America have effectively reduced CRC incidence. Among the nearly six million colonoscopies performed annually in the United States, 4%-11% detect large benign colorectal neoplasms, many of which can be removed endoscopically, minimizing the need for surgery. Endoscopic removal is less invasive, preserves bowel function and lowers healthcare costs. Despite these benefits, segmental colectomy for benign neoplasia remains common, with surgeries increasing between 2000 and 2014. To address this, efforts have focused on improving access to advanced endoscopic care through training and collaboration initiatives, although their impact on surgery rates is unclear. This study aims to evaluate temporal trends in the surgical management of benign colorectal neoplasia using data from the American College of Surgeons (ACS) National Quality Improvement Program (NSQIP) 2016-2022 database.

methodsAdult patients undergoing elective colectomy and/or proctectomy for colorectal neoplasia between 2016 and 2022 were identified in the ACS-NSQIP database utilizing Current Procedure Terminology (CPT) codes and International Classification of Diseases, Tenth Revision (ICD 10) codes. Patients were then classified based on the nature of the pathology as either benign or malignant. The primary outcome was to determine the frequency of resections per year for benign neoplasia. The secondary outcomes included postoperative 30-day overall morbidity, system-specific complications and healthcare resource utilization for patients undergoing resections for benign neoplasia. Multivariable regression models were fit to identify variables associated with each secondary outcome.

resultsOverall, 207,250 patients underwent colectomy and/or proctectomy for colorectal neoplasia between 2016 and 2022. Among them, 35,108 (17.5%) had resection for benign neoplasia. The proportion of patients undergoing resection for benign neoplasia decreased yearly from 3458 (22.5%) in 2016 to 2396 (12.7%) in 2022. Most benign lesions were in the right colon (63.5%), removed during a colectomy with primary anastomosis (91.5%), using a minimally invasive approach (82.8%). The 30-day overall morbidity and mortality was 6.8% and 0.4%, respectively. There were 1114 (3.2%) patients who required a reoperation and 2798 (8.0%) who required a readmission following surgery for benign neoplasia. Patients who were American Society of Anaesthesiologists (ASA) class 4 (odds ratio (OR) 2.13, 95% confidence interval (CI) 1.46-3.10), active smokers (OR 1.47, 95% CI 1.31-1.63) and those undergoing a proctectomy (OR 1.45, 95% CI 1.09-1.93) all had increased odds of postoperative morbidity.

conclusionOur study of the ACS-NSQIP 2016-2022 database demonstrated a temporal decrease in the proportion of elective colorectal resections for benign neoplasms every year, with associated low morbidity and mortality. Identification of patient and treatment factors associated with postoperative morbidity, such as ASA class, smoking and type of operative intervention, can help practitioners better counsel patients regarding different management strategies and effectively select patients for the approach most suitable for their presentation.