Sarath Sujatha-Bhaskar, MD1, Reza Fazl Alizadeh1, Michael Phelan2, Mehraneh D Jafari, MD1, Joseph C Carmichael, MD, FACS, FASCRS1, Michael J Stamos, MD, FACS, FASCRS1, Alessio Pigazzi, PhD, MD, FACS, FASCRS1. 1University of California, Irvine School of Medicine, 2University of California, Irvine Center for Statistical Counseling
Introduction: Patients with severe chronic obstructive pulmonary disease (COPD) are at a higher risk for postoperative respiratory complications. Despite the benefits of a minimally invasive approach, laparoscopic pneumoperitoneum can substantially reduce functional residual capacity and raise alveolar dead space, potentially elevating the risk of postoperative hypoxemia and hypercapnic respiratory failure. Reduced compensatory function in COPD increases the risk of this effect. This raises controversy as to whether open techniques should be preferentially employed in this population to mitigate this effect.
Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2006-2014 was used to examine the clinical data from patients with COPD who electively underwent laparoscopic and open colectomy. Patients defined as having COPD demonstrated either functional disability, chronic use of bronchodilators, prior COPD-related hospitalization, or reduced forced expiratory reserve volumes on lung testing (FEV1<75%). Demographic data and preoperative characteristics were compared. Linear and logistic regressions were utilized to perform multivariate analysis and determine risk-adjusted outcomes.
Results: Of the 10,743 patients with COPD, 37% underwent laparoscopic colectomy (LC) and 63% underwent open colectomy (OC). The LC and OC groups were similar in terms of demographic data and preoperative comorbidities. Median age was approximately 70 for both patient groups. Equivalent frequencies of moderate exertional dyspnea were present (35% LC, 35% OC, p=0.43). After multivariate risk adjustment, patients undergoing LC demonstrated an overall reduction in the risk of respiratory complications including pneumonia, re-intubation, and prolonged ventilator dependency when compared to OC (OR 0.52, 95% CI 0.46-0.59, P < 0.01). LC exhibited a lower risk of serious morbidity (OR 0.49, 95% CI 0.45-0.54, P < 0.01) and 30-day mortality (OR 0.39, 95% CI 0.31-0.50, P < 0.01). LC demonstrated lower risk of readmission (OR 0.77, 95% CI 0.65-0.91, P <0.01). Length of initial hospitalization after LC was 4.27 days shorter (3.88-4.65 days, p < 0.01) than OC.
Conclusion: Despite the potential risks of laparoscopic pneumoperitoneum in the susceptible COPD population, a minimally invasive approach was associated with lower risk of postoperative respiratory complications, shorter length of stay, and decrease in readmission.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79470
Program Number: S047
Presentation Session: Colorectal 1
Presentation Type: Podium