A Nationwide Analysis of Laparoscopy in High-Risk Colorectal Surgery Patients

Celeste Y. Kang, Wissam J Halabi, Obaid O. Chaudhry, Vinh Nguyen, Noor Ketana, Joseph C. Carmichael, Alessio Pigazzi, Michael J. Stamos, Steven Mills

Research output: Contribution to journalReview article

26 Citations (Scopus)

Abstract

Background: Due to safety concerns, the use of laparoscopy in high-risk colorectal surgery patients has been limited. Small reports have demonstrated the benefit of laparoscopy in this population; however, large comparative studies are lacking. Study Design: A retrospective review of the Nationwide Inpatient Sample 2009 was conducted. Patients undergoing elective colorectal resections for benign and malignant pathology were included in the high-risk group if they had at least two of the following criteria: age > 70, obesity, smoking, anemia, congestive heart failure, valvular disease, diabetes mellitus, chronic pulmonary, kidney and liver disease. Using multivariate logistic regression, the outcomes of laparoscopic surgery were compared to open and converted surgery. Results: Of 145,600 colorectal surgery cases, 32.79% were high-risk. High-risk patients had higher mortality, hospital charges, and longer hospital stay compared to low-risk patients. The use of laparoscopy was lower in the high-risk group with higher conversion rates. In high-risk patients, compared to open surgery, laparoscopy was associated with lower mortality (OR = 0.60), shorter hospital stay, lower charges, decreased respiratory failure (OR = 0.53), urinary tract infection (OR = 0.64), anastomotic leak (OR = 0.69) and wound complications (OR = 0.46). Conversion to open surgery was not associated with higher mortality. Conclusions: Laparoscopy in high-risk colorectal patients is safe and may demonstrate advantages compared to open surgery.

Original languageEnglish (US)
Pages (from-to)382-391
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume17
Issue number2
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

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Colorectal Surgery
Laparoscopy
Mortality
Length of Stay
Conversion to Open Surgery
Hospital Charges
Anastomotic Leak
Chronic Renal Insufficiency
Urinary Tract Infections
Respiratory Insufficiency
Lung Diseases
Liver Diseases
Anemia
Inpatients
Diabetes Mellitus
Heart Failure
Obesity
Logistic Models
Smoking
Pathology

Keywords

  • Colon cancer
  • Colorectal polyps
  • Colorectal surgery
  • Diverticular disease
  • Diverticulitis
  • High risk
  • Laparoscopic
  • Nationwide inpatient sample
  • Rectal cancer

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Kang, C. Y., Halabi, W. J., Chaudhry, O. O., Nguyen, V., Ketana, N., Carmichael, J. C., ... Mills, S. (2013). A Nationwide Analysis of Laparoscopy in High-Risk Colorectal Surgery Patients. Journal of Gastrointestinal Surgery, 17(2), 382-391. https://doi.org/10.1007/s11605-012-2096-y

A Nationwide Analysis of Laparoscopy in High-Risk Colorectal Surgery Patients. / Kang, Celeste Y.; Halabi, Wissam J; Chaudhry, Obaid O.; Nguyen, Vinh; Ketana, Noor; Carmichael, Joseph C.; Pigazzi, Alessio; Stamos, Michael J.; Mills, Steven.

In: Journal of Gastrointestinal Surgery, Vol. 17, No. 2, 01.01.2013, p. 382-391.

Research output: Contribution to journalReview article

Kang, CY, Halabi, WJ, Chaudhry, OO, Nguyen, V, Ketana, N, Carmichael, JC, Pigazzi, A, Stamos, MJ & Mills, S 2013, 'A Nationwide Analysis of Laparoscopy in High-Risk Colorectal Surgery Patients', Journal of Gastrointestinal Surgery, vol. 17, no. 2, pp. 382-391. https://doi.org/10.1007/s11605-012-2096-y
Kang, Celeste Y. ; Halabi, Wissam J ; Chaudhry, Obaid O. ; Nguyen, Vinh ; Ketana, Noor ; Carmichael, Joseph C. ; Pigazzi, Alessio ; Stamos, Michael J. ; Mills, Steven. / A Nationwide Analysis of Laparoscopy in High-Risk Colorectal Surgery Patients. In: Journal of Gastrointestinal Surgery. 2013 ; Vol. 17, No. 2. pp. 382-391.
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