Catherine M Hambleton Davis, MD1, Beverly A Shirkey, PhD2, Linda W Moore, MS, RDN, LD, CCRP1, H. Randolph Bailey, MD1, Brian J Dunkin, MD1, Marianne V Cusick, MD, MPH1. 1Houston Methodist Hospital, 2University of Oxford
Background: Previous analysis has suggested that laparoscopic surgery is being widely adopted in the field of colorectal surgery (CRS), including in higher risk and more acutely ill patients. The goal of the current study is to analyze surgical outcomes in laparoscopic versus open CRS as minimally invasive technique is applied more broadly.
Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005-2014, colorectal procedures were identified by CPT codes and categorized to open or laparoscopic surgery. Overall and yearly means and rates were then calculated for 16 outcomes measures.
Results: A total of 277,376 colorectal cases were identified, 114,359 (41.2%) performed laparoscopically. The use of laparoscopy increased yearly, from 22.7% in 2005 to 41.2% in 2014. Differences were noted in all analyzed 30-day outcomes in the laparoscopic versus open groups: death (0.90% (0.85-0.96) vs. 5.48% (5.37-5.59)), cardiac arrest requiring CPR (0.30% (0.27-0.34) vs. 1.21% (1.16-1.27)), stroke (0.18% (0.16-0.21) vs. 0.50% (0.47-0.54)), myocardial infarction (MI) (0.37% (0.33-0.40) vs. 0.94% (0.90-0.99)), pulmonary embolism (0.46% (0.42-0.50) vs. 0.97% (0.92-1.02)), deep vein thrombosis (0.92% (0.87-0.98) vs. 2.21% (2.14-2.28)), pneumonia (1.38% (0.31-1.45) vs. 4.94% (4.84-5.05)), ventilator >48 hours (1.07% (1.01-1.13) vs. 7.45% (7.33-7.58)), superficial surgical site infection (SSI) (4.69% (4.57-4.82) vs. 8.56% (8.42-8.69)), deep incisional SSI (0.88% (0.83-0.94) vs. 2.17% (2.10-2.24)), organ space infection (3.18% (3.01-3.29) vs. 5.76% (5.64-5.87)), renal insufficiency (0.47% (0.44-0.52) vs. 1.19% (1.14-1.24)), acute renal failure (0.31% (0.28-0.34) vs. 1.40% (1.34-1.46)), urinary tract infection (2.31% (2.23-2.41) vs. 4.34% (4.24-4.44)), operating room time (174.3 minutes (173.8-174.8) vs. 167.5 (167.0-168.0)), and length of hospital stay (6.3 days (6.2-6.3) vs. 11.5 (11.4-11.5)), respectively. Additionally, death and stroke tended to decrease over time in the laparoscopic cohort from 1.41% to 0.78% and 0.28 to 0.16%, respectively, while no change or increase was seen in the open cohort. MI tended to increase over time in the open cohort from 0.42% to 1.12%, but not in the laparoscopic cohort.
Conclusion: Over a ten-year period, 30-day outcomes favored laparoscopic over open CRS. Additionally, select outcomes demonstrated improvement in the laparoscopic cohort over time compared to the open cohort. Given the increase in laparoscopic CRS in more complex patients, improved quality in laparoscopy is suggested. However, it is possible that observed differences may be due to unequal characteristics of the two groups of patients. Further analysis is needed to evaluate improved proficiency in laparoscopic surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78056
Program Number: P220
Presentation Session: Poster (Non CME)
Presentation Type: Poster
