Morbidity and Mortality After Surgery for Nonmalignant Colorectal Polyps: A 10-Year Nationwide Analysis.

"CONFLICTS OF INTEREST Guarantor of the article: Jeffrey K. Lee, MD, MPH, MAS. Specific author contributions: C.M. and A.T. contributed equally to this work. C.M., A.T., J.K.L.: study concept and design, data analysis, data interpretation, and manuscript drafting and editing for important intellectual content. S.S.: manuscript drafting and editing for important intellectual content. N.F., S.J.H., T.L.J., C.A.M., V.J., D.A.C.: manuscript editing for important intellectual content. All authors approve the final version of this study. Financial support: C.M. is supported by a Clinician Fellowship from the Canadian Institutes for Health Research, Crohn's and Colitis Canada, and the Canadian Association of Gastroenterology. J.K.L. is supported by a career development grant (K07 CA212057) from the National Cancer Institute and American Gastroenterological Association Research Scholar Award. D.A.C. is supported by a National Cancer Institute grant (UM1 CA222035). Potential competing interests: C.M., A.T., S.S. have no relevant conflicts of interest. N.F. has received research support and speaker's honoraria from Pentax and Boston Scientific. S.J.H., T.L.J., C.A.M., V.J., D.A.C., J.K.L. have no relevant conflicts of interest.Study HighlightsWHAT IS KNOWN✓ Screening and endoscopic polypectomy reduce the incidence of and mortality from CRC.✓ Most large or complex colorectal polyps can be safely removed by endoscopic resection.✓ Although endoscopic resection is the preferred first-line modality of treatment, surgery for nonmalignant colorectal polyps may be required and the rates are increasing in the United States.WHAT IS NEW HERE✓ In a 10-year analysis of more than 260,000 surgeries for nonmalignant colorectal polyps using a nationally representative sample (NIS), we determined that 0.8% of patients will die in the hospital. Moreover, 25.3% of patients will experience a postoperative adverse event, which is higher than that previously reported in a large quality assurance surgical cohort.✓ Surgery-, patient-, and system-related factors that increase the risk of adverse postoperative outcomes include open laparotomy, older age, male sex, burden of comorbidities, black race, Medicaid use, and admission to a rural hospital.✓ Surgery for nonmalignant colorectal polyps is associated with significant resource use and morbidity. Given published safety and effectiveness data on endoscopic resection of large nonmalignant polyps, patients with such polyps should have an evaluation for the appropriateness of endoscopic resection."

"Financial support: C.M. is supported by a Clinician Fellowship from the Canadian Institutes for Health Research, Crohn's and Colitis Canada, and the Canadian Association of Gastroenterology. J.K.L. is supported by a career development grant (K07 CA212057) from the National Cancer Institute and American Gastroenterological Association Research Scholar Award. D.A.C. is supported by a National Cancer Institute grant (UM1 CA222035)."