Adverse Events After Nonmalignant Colon Polyp Surgery Increase Treatment Costs

Endoscopic management of large benign colorectal lesions is safe and effective. To treat patients with a minimally invasive technique, which has less morbidity and mortality as compared with surgery, is not only indicated but also makes ethical and fiscal sense. While a partial colectomy may be perceived to have less morbidity than a proctectomy and a colostomy, there are few reasons to refer patients to undergo surgery for a benign lesion that can be cured with an outpatient endoscopy. Advances in knowledge, technology, and technique over the past decade have propelled endoscopic resection for benign colon and rectal lesions as the first-line treatment.

In the August issue of Gastrointestinal Endoscopy, Keswani and coauthors highlight the clinical and financial burden of the surgical management for benign colon polyps—an alternative, often neglected, perspective. Using over a decade of real-world data, the authors report that approximately one-sixth of patients who undergo surgery for a nonmalignant colon polyp will suffer an adverse event that results in a readmission or a prolonged index hospitalization. When an adverse event occurred, the median length of stay was 11 days. The most common adverse events resulting in readmission were infection and anastomotic leaks. The cohort of 359 patients who underwent surgery for a nonmalignant polyp included an equal distribution of men and women; the majority (73%) was ASA class I or II, and had a mean age of 64 ± 11. The risk of an adverse event did not differ by open or laparoscopic surgical approach or location of polyp among the 18 different surgeons.

Keswani’s and colleagues’ study also expands on prior work suggesting that the cost-effectiveness of endoscopic management of colon polyps compared with that of surgery. They present “head-to-head” data showing that endoscopic resection is associated with a lower rate of adverse events (10% versus 18%), significantly lower median length of stay (0 days versus 5 days), and significantly lower costs (on average, $13,000 less than surgical resection of a nonmalignant polyp)—even after accounting for adverse events, unexpected malignancy, resection failures requiring surgery, and surveillance colonoscopies.

Such data need to be shared with patients and providers. It is time to move the practice and culture forward. Endoscopic resection of nonmalignant colon polyps should unquestionably be the standard of care. It is safer and more efficacious and cost-effective compared with surgery.