Declining Rates of Surgery for Nonmalignant Colorectal Polyps in the United States Over the Last Decade: A Real-World Analysis of Over 1 Million Patients

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Abstract Background Despite advancements in endoscopic resection (ER), surgery for nonmalignant colorectal polyps remains common. A prior analysis reported increasing surgical rates from 2000 to 2014. Using the TriNetX US Research Network, we aimed to compare the proportion of patients referred for ER versus surgical colectomy for nonmalignant polyps each year from 2015 to 2023. Methods We identified adults (≥18 years) diagnosed with nonmalignant colorectal polyps following colonoscopy using validated ICD-10 and CPT codes. Patients with colorectal cancer or inflammatory bowel disease were excluded. The primary outcome was incidence of ER (EMR or ESD) vs. colectomy between 2 weeks and 6 months post-colonoscopy. Secondary outcomes included 30-day adverse events (AEs) and mortality. Propensity score matching was used to compare groups. Odds ratios (ORs) were calculated for secondary outcomes. Results Of 1,060,302 patients undergoing colonoscopy from 2015 to 2023, 6,295 (0.594%, 95% CI: 0.579–0.609%) were referred for ER and 4,208 (0.397%, 95% CI: 0.385–0.409%) were referred surgery for large nonmalignant colorectal polyps detected and not resected on index colonoscopy. ER incidence rose from 0.26% (2015) to 0.67% (2023), while surgery rates declined from 0.45% to 0.35%. Post-matching, ER was associated with significantly lower 30-day mortality (0.161% vs. 1.304%; OR: 0.122) and fewer AEs, including cardiac events, thromboembolic events, pulmonary complications, sepsis, and surgical site infections. Discussion Over the past decade, ER for nonmalignant colorectal polyps increased while surgical resections declined. ER was associated with significantly lower mortality and morbidity. These findings support continued efforts to promote ER as a safer, effective alternative to surgery.