A nationwide analysis of laparoscopy in high-risk colorectal surgery patients. Academic Article uri icon

Overview

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.

publication date

  • December 1, 2012

Research

keywords

  • Colonic Diseases
  • Colorectal Neoplasms
  • Laparoscopy
  • Rectal Diseases

Identity

Scopus Document Identifier

  • 84872599266

Digital Object Identifier (DOI)

  • 10.1007/s11605-012-2096-y

PubMed ID

  • 23212528

Additional Document Info

volume

  • 17

issue

  • 2