Marlin W Causey, MD, Derek P Mcvay, MD, Eric K Johnson, MD, Justin A Maykel, MD, Matthew J Martin, MD, David Rivadeneira, MD, Scott R Steele, MD. Madigan Healthcare System; University of Massachusetts; St. Catherine of Siena Medical Center
INTRODUCTION: Varying outcomes have been reported for the numerous surgical approaches for ulcerative colitis (UC). We set out to investigate the outcome of patients undergoing surgery for UC by analyzing a large nationwide database.
METHODS AND PROCEDURES: We queried the American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP, 2005-2008) for all UC patients undergoing colectomy. To analyze by operation, groupings included: partial colectomy (PC; n=265), total abdominal colectomy (TAC; n=232), total proctocolectomy with ileostomy (TPC-I; n=134), and total proctocolectomy with ileal pouch-anal anastomosis (IPAA; n=446). Risk-adjusted 30-day outcomes were assessed using regression model analysis for patient demographics, steroid use, co-morbidities, and surgical procedure.
RESULTS: From 1,077 patients (mean age 44 years; 45% female; 7% emergent), a laparoscopic approach was used in 29.2% with rates increasing 8.5% each year (18.5% in 2005 to 41.3% in 2008, P<0.001) and there was no difference in obese patients (P=0.64 & P=0.73, respectively). Complications occurred in 29%, and laparoscopy was associated with a lower complication rate (21% vs. 32% open, P<0.001). On multivariate regression, postoperative complications increased when patients were not functionally independent (odds ratio (OR)=2.8), had preoperative sepsis (OR=2.2) or prior percutaneous coronary intervention (OR=2.6). Only a laparoscopic approach was associated with a lower complication rate (OR 0.63; 95% CI, 0.46 – 0.86). When stratified by specific complications, laparoscopy was associated with lower complications including superficial surgical site infections (11.4% vs. 6.7%, P=0.0011), pneumonia (2.9% vs. 0.6%, P=0.023), prolonged mechanical ventilation (3.9% vs. 1.3%, P=0.023), need for transfusions postoperatively (1.6% vs. 0%, P=0.016), and severe sepsis (2.9% vs. 1.0%, P=0.039). Laparoscopy was also associated with a lower complication rate in TACs (41.7% vs. 18.8%, P<0.0001) and IPAA (29.9% vs. 18.2%, P=0.005) and had an overall lower mortality rate (0.2% vs 1.7%, P=0.046).
CONCLUSION(S): Results from a large nationwide database demonstrate that a laparoscopic approach was utilized in a third of UC patients undergoing colectomy, and was associated with lower morbidity and mortality, even in more complex procedures such as TAC and IPAA.
Session Number: Poster – Poster Presentations
Program Number: P057