A measure of recovery after laparoscopic vs open abdominal surgery in elderly patients

Fadi Hamadani, MD, Shanon Fraser, MD, FRCSC, FACS, Michele Monette, MSc, Geva Maimon, PhD, Nadia Sourial, MSc, Debbie Teasdale, RN, Helena Zakrzewski, BSc, Simon Bergman, MD, MSc, FRCSC, FACS. Jewish General Hospital, McGill University.

Introduction

Advances in perioperative care and the resulting improvements in outcomes such as length of stay and complications can make comparisons between laparoscopic and open surgery difficult. Recovery may be a construct that is more relevant to patients and better able to discern differences between different approaches. The purpose of this study is to describe the recovery of functional status in elderly patients undergoing laparoscopic versus open surgery.

Methods and Procedures

This is an ongoing prospective cohort study of 55 patients aged 70 or older who underwent major elective surgery, laparoscopic (n=12) or open (n=43), between October 2012 and July 2013. Patient characteristics were recorded including age, sex, Charlson Comorbidity Index (CCI), diagnosis, and procedure type. The primary outcome was lower-body function, as measured by the Short Physical Performance Battery (SPPB), a tool designed to quantify performance and decline over time, at 4 time points: preop, 1 week postop, 1 month postop, and 3 months postop. Patients were considered recovered when their postop scores was equal or higher than their preop scores. We provide descriptive results for exploratory purposes with group means compared using an unpaired Student’s t-test. Proportions were tested using a Z-test of proprtions and medians were tested using Mann-Whitney U test with p-values reported.

Results
The mean age in the open group was 77.5 +/- 3.9 and in the laparoscopic group 76.9 +/- 3.8 (p=0.43). Males made up 56.4% of the open group 67% of the laparoscopy cohort (p=0.52). The comorbidity status was similar in both groups with a median CCI median of 6.5 in the open group and 7.5 in the laparoscopic group (p=0.38). Procedure types and cancer diagnosis were similar in both groups. The total percentage of patients with one or more complications in the open patient group was 35% versus 33% in the laparoscopic group (p=0.45). Mean LOS was 6.5 +/- 4.7 in the open patients and 5.5 +/- 6.7 in the laparoscopic group (p=0.58). A higher percentage of laparoscopic patients (71.4%) recovered to baseline SPPB levels at 3 months than in the open group (60%) (p=0.032).

Conclusion

Preliminary data suggest that the SPPB may be a good measure to compare recovery in elderly surgical patients following laparoscopic and open surgery.

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