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 language | English (US) |
|---|---|
| Pages (from-to) | 382-391 |
| Number of pages | 10 |
| Journal | Journal of Gastrointestinal Surgery |
| Volume | 17 |
| Issue number | 2 |
| DOIs | |
| State | Published - Jan 1 2013 |
| Externally published | Yes |
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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
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 journal › Review article
}
TY - JOUR
T1 - A Nationwide Analysis of Laparoscopy in High-Risk Colorectal Surgery Patients
AU - Kang, Celeste Y.
AU - Halabi, Wissam J
AU - Chaudhry, Obaid O.
AU - Nguyen, Vinh
AU - Ketana, Noor
AU - Carmichael, Joseph C.
AU - Pigazzi, Alessio
AU - Stamos, Michael J.
AU - Mills, Steven
PY - 2013/1/1
Y1 - 2013/1/1
N2 - 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.
AB - 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.
KW - Colon cancer
KW - Colorectal polyps
KW - Colorectal surgery
KW - Diverticular disease
KW - Diverticulitis
KW - High risk
KW - Laparoscopic
KW - Nationwide inpatient sample
KW - Rectal cancer
UR - http://www.scopus.com/inward/record.url?scp=84872599266&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84872599266&partnerID=8YFLogxK
U2 - 10.1007/s11605-012-2096-y
DO - 10.1007/s11605-012-2096-y
M3 - Review article
C2 - 23212528
AN - SCOPUS:84872599266
VL - 17
SP - 382
EP - 391
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
SN - 1091-255X
IS - 2
ER -