Mark H Hanna, MD1, Grace S Hwang, MD2, Michael J Phelan, PhD3, Alessio Vinci, MD1, Joseph C Carmichael, MD1, Alessio Pigazzi, MD, PhD1, Michael J Stamos, MD1, Steven Mills, MD1. 1University Of California – Irvine, Dept of Surgery, 2University of Southern California, Dept of Surgery, 3Department of Statistics, University of California Irvine
Introduction: Laparoscopic–assisted surgery for Inflammatory Bowel Disease (IBD) has been gaining in popularity over the past decade. However, there remains a paucity of large, population-based studies comparing the trends and outcomes of Laparoscopic Surgery (LS) to the more established Open Surgical (OS) technique.
Materials and Methods: The Nationwide Inpatient Sample (NIS) database was used to retrospectively identify patients who underwent LS and OS for IBD from 2009 to 2012. Trends in different hospital settings, indications, and demographics were analyzed. Multivariate regression analysis was used to compare selected postoperative outcomes and complications between LS and conventional OS.
Results: A total of 8,989 colorectal resections were performed for IBD over the study period, with 32% of cases utilizing LS. A total of 6,029 resections were preformed for Crohn’s Disease (CD) with 68% of cases using OS and 32% using LS. A total of 2,960 resections were performed for Ulcerative Colitis (UC), 69% using OS and 31% using LS. From 2009 to 2012, the use of LS increased in all hospital settings from ~30% to 35% with it being most common in large, urban, teaching hospitals. The most common LS cases for IBD included right hemicolectomy 1,050 (37%), ileocectomy 653 (23%), total abdominal colectomy 512 (18%), total colectomy with permanent ileostomy 203 (7%), sigmoidectomy 180 (6%) and total colectomy with pouch 138 (5%). Using multivariate analysis to control for case selection bias and to compare OS and LS in Crohn’s Disease cases, LS was associated with significantly shorter length of stay (LOS) (-1.54 days, P<0.01), decreased hospital costs (-$4,973.87, P<0.05), lower morbidity AOR=0.76 (P<0.01), lower incidence of anastomotic leak AOR=0.57 (P<0.01) and lower incidence of wound infections AOR=0.71 (P<0.05). Furthermore, among ulcerative colitis cases, LS was associated with significantly shorter LOS (-1.29 days, P<0.01), lower morbidity AOR= 0.69 (P<0.01) and lower incidence of wound infections AOR= 0.57 (P<0.01). No significant differences were found in overall mortality, post-operative bleeding and incidence of ileus/bowel obstruction in both CD and UC when compared to OS.
Conclusions: Laparoscopic-assisted surgery for IBD is limited but increasing in prevalence, comprising a total of 32% of colorectal cases nationwide. LS was associated with significantly shorter LOS, lower morbidity, and lower incidence of wound infections in both CD and UC patients. LS showed a significantly lower incidence of anastomotic leak only in CD patients. LS did not significantly change overall mortality. Large prospective randomized trials are needed to validate these findings.