Declining Colectomy Rates for Benign Colorectal Polyps in an Integrated Health Care System in the U.S.
Douglas K. Rex, MD, MASGE, reviewing Alam A, et al. Clin Transl Gastroenterol 2022 Mar 28.
Population-based studies have found no decline in colectomy rates for benign colorectal polyps over the past 10 to 15 years, even though a recent study has suggested rates have begun to decline in the last few years. This study examined rates of colectomy for benign polyps in a single health care system in California (Kaiser Permanente Northern California) from 2008 to 2018.
The denominator for colectomy rates was patients diagnosed with benign polyps by colonoscopy. Among 229,730 such patients, 1611 underwent colectomy. The colectomy rate dropped from 125 per 10,000 patients to 12 per 10,000 over the interval, and the decline was present across patients of different ages, sex, race, and ethnicity.
Within this health care system, advanced endoscopic resection was made available in the San Francisco area in 2010 and expanded thereafter. From 2010 to 2018, colectomy rates declined from 1.15% to 0.12%.
The authors attributed the decline to 3 factors:
- Availability of advanced endoscopic resection
- Widespread screening so that polyps were more likely to be discovered earlier when endoscopic resection is more feasible
- Integration of the health care system, with coordination between specialists regarding goals for optimal patient outcome
COMMENTThese results are encouraging and provide a different and important way to examine colectomy rates. It would be helpful to understand certain factors better, including the impact of earlier detection, the availability of advanced endoscopic resection, and why some patients with benign colorectal polyps still undergo colectomy.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Alam A, Ma C, Jiang SF, et al. Declining colectomy rates for nonmalignant colorectal polyps in a large, ethnically diverse, community-based population. Clin Transl Gastroenterol 2022 Mar 28. (Epub ahead of print) (https://doi.org/10.14309/ctg.0000000000000477)
