Impact of Surgical Approach On Short Term Outcomes After Colectomy in Elderly Patients: A National Surgical Quality Improvement Program Database Analysis (2005-2012)

Umashankkar Kannan, MD, Vemuru Sunil K Reddy, MD, Amarnath Mukerji, MD, Brian Gilchrist, Ajay Shah, Vellore S Parithivel, Daniel Farkas. Bronx Lebanon hospital center, Bronx, NY

Background:

Laparoscopic colectomy has shown comparable outcomes with open colectomy. Its role in the elderly is not well studied. The objective of this retrospective study is to compare the 30 day outcomes after laparoscopic versus open approach for colectomy in patients aged 65 years and over.

Methods:

The American College of surgeons – National Surgical quality Improvement program (ACS- NSQIP) database for the years 2005-2012 was queried for all patients 65 years and older who underwent colectomy. Comparison between the laparoscopic and open groups was performed using the Chi-Square test and Fisher’s exact test for discrete variables and Students’ t – test for continuous variables. In addition to aggregate analysis, Propensity score 1: 1 matching using the nearest- neighbour method was performed to reduce the selection bias. p< 0.05 was considered significant and Odds ratios (OR) with 95% confidence interval (CI) were reported when applicable.

Results:

We identified 37,358 elderly patients who underwent colectomy. Thirty five percent ( 12, 881) of the cases were done laparoscopically. In the aggregate cohort, Open approach was associated with higher overall morbidity (39% vs 17%) and Mortality (6% vs 1.6%). In the matched cohort after propensity matching, Open approach still had higher overall morbidity (26% vs 17%) and mortality (3 % vs 1.6%). The open approach was also associated with higher cardiac, pulmonary and renal complications. Laparoscopic approach was associated with shorter length of stay (6.7 days vs 11 days in aggregate cohort and 9.6 days in the matched cohort).

Conclusions:

Using the ACS- NSQIP database, laparoscopic approach for colectomy has favorable short term outcomes with lesser overall morbidity, mortality, shorter length of stay in the elderly patients.