Laparoscopic Colectomy Is Safer Than Open Colectomy: A Propensity Score Matched, Risk-Adjusted Analysis From 183 Hospitals

INTRODUCTION: Though patient preference appears to drive the move to laparoscopic colectomy, it is uncertain whether surgeons should preferentially offer a laparoscopic approach over an open approach because of increased safety alone. There has not been adequate multi-institutional evidence comparing appropriate patient cohorts to answer this important question.
METHODS: From 2005-2007, 183 hospitals participating in the ACS-NSQIP collected clinical information on a sample of 21,083 segmental colectomies without colostomy. In order to construct a study group for which there was plausible equipoise regarding surgical approach (open v. laparoscopic), this cohort of patients was further restricted via clinical exclusions and propensity score matching. Only same-day admissions were considered, and patients with emergency cases, contaminated operative fields and other relevant clinical factors were excluded. From this restricted cohort, propensity scores for laparoscopy were then used to match (1:1) members of the laparoscopic and open groups, yielding 5,984 patients. Univariate analyses, and risk adjusted analyses with stepwise multivariate models were performed.
RESULTS: Matched on propensity score, open and laparoscopic cohorts showed statistically similar rates of nearly all comorbidities. Univariate analyses show:After risk-adjustment, the laparoscopic approach continues to have a lower rate of major complication (OR= 0.61 [95% CI: 0.50, 0.73]).
CONCLUSIONS: This risk-adjusted, propensity score matched analysis demonstrates that patients undergoing laparoscopic (compared to open) segmental colectomy have fewer major and minor complications and have a shorter postoperative length of stay. In appropriate patients, laparoscopic colectomy should be performed instead of open colectomy when feasible.

Session: Podium Presentation

Program Number: S037