Comparison of Clavien Class IV and V Complications for Laparoscopic Versus Open Colectomy Using NSQIP Data and Risk Adjustment

Shawn Webb, MD, Ilan Rubinfeld, MD, Velanovich Vic, MD, M H, MD, Reickert Craig, MD. Henry Ford Health Systems

Introduction: Is laparoscopic colectomy independently protective from ICU level complications when compared to open colectomy? Laparoscopic colectomy has been associated with fewer postoperative complications compared to open colectomy. However, it is unclear whether this is true for the most severe complications typically requiring treatment in an intensive care unit. We performed a risk adjusted comparison of laparoscopic vs open colectomy.
Methods: Using the NSQIP Public Use files (2005-2008), we identified all laparoscopic and open colectomies by CPT code. Using the Clavien classification for postoperative complications, we identified NSQIP data points most consistent with Clavien Class IV requiring ICU care (postoperative septic shock, postoperative dialysis, pulmonary embolism, MI, cardiac arrest, prolonged ventilatory requirements, need for reintubation) or class V (mortality). Statistical analysis was performed with SPSS software (SPSS, Chicago, IL). Odds ratios were calculated to determine probability of having any Clavien class IV or V complication comparing laparoscopic versus open colectomy. Logistic regression was performed to account for preoperative conditions effect on complications (ASA class, wound class, gender, preoperative functional status, preoperative albumin level, azotemia, thrombocytopenia, emergency case, and age > 70).

ColectomyLaparoscopicOpenUnivariate X2 Odds Ratio
(p<.001 for all variables)
Multivariate Logistic regression OR
(p<0.001 for all)
Total patients (N)12,45533,190
Septic shock1.5%5.6%3.881.64
Q-wave infarct0.2%0.5%2.991.63
Cardiac arrest0.3%1.2%4.272.21
Pulmonary embolism0.4%1.0%2.271.87
Prolonged ventilation1.6%8.9%5.951.77
Any Clavien class IV or V complication3.6%15.4%4.871.74

The univariate odds ratio of having any complication requiring ICU admission ranged from 2.27 to 5.52 times more likely if surgery was performed open than with a laparoscopic approach. Multivariate logistic regression accounting for preoperative comorbidities that might affect outcome showed a persistence of an increase in complications with an odds ratio range of 1.63 to 2.21.
Conclusion: Evaluation of NSQIP database demonstrates laparoscopic colectomy confers an independent protective effect on the frequency of ICU level (Clavien class IV) complicationsand mortality (Clavien class V). The protective effect remained evident after correcting for preoperative conditions that might have affected outcome.

Session: SS14
Program Number: S086

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