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

30 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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  • Cite this

    Kang, C. Y., Halabi, W. J., Chaudhry, O. O., Nguyen, V., Ketana, N., Carmichael, J. C., Pigazzi, A., Stamos, M. J., & 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