Daniel L Davenport, PhD1, Walker R Ueland, BSc2, Margaret Plymale, DNP3, Andrew C Bernard, MD3, John S Roth, MD3. 1University of Kentucky, Department of Surgery, 2University of Kentucky, College of Medicine, 3University of Kentucky, Division of General Surgery
Introduction: We sought to compare 30-day outcomes in patients undergoing emergent open and laparoscopic repair of perforated gastric ulcers in a recent, large, multicenter cohort.
Methods and Procedures: A retrospective review of the prospectively obtained data in the American College of Surgeons National Surgical Quality Improvement Program public use files from 2010 through 2015. Cases were selected using ICD-9/10™ and CPT™ codes. Perioperative risks and 30-day outcomes were compared in unmatched and propensity matched groups using parametric or non-parametric statistical tests as appropriate. Significance was set at p < .05.
Results: A total of 3,486 procedures were identified, 265 (7.6%) laparoscopic, and 3221 (92.4%) open. Laparoscopic repairs increased from 4.2% of 2010 cases to 10.3% of 2015 cases (Figure, p < .001). Open repair patients had higher rates of numerous clinical factors indicating more acute presentation including ASA class, hypoalbuminemia, preoperative septic shock, renal failure and mechanical ventilation (all p < .01). The average duration of the operation was 19 minutes higher (p < .001) in the laparoscopic group. Mortality (8.9% vs. 4.2%), median length of stay (7 vs. 5), transfusion rates, renal failure and respiratory outcomes were all worse in the unmatched open group (all p < .01).
The propensity matching resulted in 235 laparoscopic and 437 open cases of similar age, ASA class, preoperative SIRS/sepsis, hypoalbuminemia, and wound class. The matched groups had few patients with preoperative septic shock given it was rare in the laparoscopic group. Mortality did not differ between the matched groups (4.7% Lap. vs. 5.7% Open, p = .720), nor did most complication rates. Operative duration was 20 minutes longer in the laparoscopic group (p < .001). Median length of stay was 1 day longer in the open group (6 [5-9] vs. 5 [4-7], p < .001) which also had higher rates of prolonged ventilation (7.8% vs. 3.4%, p = .029). Return to the operating room and readmission within 30 days did not differ between the two matched groups.
Conclusions: We have shown in a contemporary, large multicenter cohort of patients that emergent laparoscopic repair of perforated gastric ulcer is increasingly being performed, is safe relative to open repair (in patients without preoperative septic shock), and confers a modest benefit in terms of length of stay and respiratory complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84920
Program Number: P057
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster