Reza Fazl Alizadeh, MD, Sarath Sujatha-Bhaskar, MD, John V Gahagan, MD, Shiri Li, MD, PhD, Mehraneh D Jafari, MD, Joseph C Carmichael, MD, FACS, FASCRS, Alessio Pigazzi, MD, PhD, FACS, FASCRS, Michael J Stamos, MD, FACS, FASCRS. University of California,Irvine School of Medicine
INTRODUCTION: With growing usage of minimally invasive approaches, utilization of laparoscopy in technically challenging cases is becoming increasingly prevalent. This increased use of MIS has generally been accompanied by prolongation of the operative time (OT). We investigated how the OT affect the outcomes of laparoscopic partial colectomy (LPC).
METHODS AND PROCEDURES: The ACS-NSQIP targeted colectomy files were utilized to identify patients who underwent elective LPC from 2012 to 2014. All patients underwent primary anastomosis. Exclusion factors included conversion to open procedure, ostomy formation, and emergent procedures. Patients were divided into four groups (L1-L4) based on mean OT (167 minutes) and standard deviation (SD, ±78 min). This defined L1 as two SD less than the mean (OT < 89 min), L2 as one SD less than the mean (90min
RESULTS: Of 11255 patients, 1144 (10.2%) were L1, 5690 (50.5%) were L2, 3366 (29.9%) were L3, and 1055 (9.4%) were L4. Following risk adjustment, there was no significant difference in 30-day mortality and morbidity rates in L2 group compared to L1. 30-day mortality rate was not significantly different between L2 and L3, but serious morbidity rate was significantly higher in L3 patients compared to L2 (14.1% vs. 11.8%, AOR: 1.23, P=0.001). Also, patients in L3 had higher risk of surgical site infections (SSI) than L2 (7.4% vs. 5.5%, AOR: 1.27, P=0.007). Notably, Anastomotic leak and postoperative ileus were significantly higher in L3 compared to L2 (2.6% vs. 1.8% and 7.5% vs. 6.2%, respectively, P<0.05). Patients in L4 had higher serious morbidity, risk of SSI, anastomotic leak, and ileus compared to L2 (P<0.05). Patients in L4 had no significant differences in terms of mortality and morbidity compared to L3 except for prolonged hospitalization (more than 30 days) and renal insufficiency which were significantly higher in L4 group (0.9% vs. 0.2% and 0.6% vs. 0.1%, respectively, P<0.05).
CONCLUSION(S): Our data revealed that patients with shorter operative times experience significantly lower serious morbidity, risk of SSI, anastomotic leak, and ileus compared to patients whose operative times exceed the mean. These findings suggest that LPC procedures with OT longer than average (167 min) have higher postoperative complications compared to the resections with OT shorter than average.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80227
Program Number: P205
Presentation Session: Poster (Non CME)
Presentation Type: Poster