Piyush Kalakoti, Paolo Goffredo, Alan Utria, Imran Hassan. University of Iowa Hospitals & Clinics
| Outcomes |
Open-Proctocolectomy(n=97) |
Laparoscopic-Proctocolectomy(n=159) |
P-Value |
| Superficial SSI,n(%) | 8(8.2) | 3(1.9) | 0.023 |
| Deep SSI, n(%) | 2(2.1) | 1(0.6) | 0.301 |
| Organ SSI,n(%) | 2(2.1) | 8(5.0) | 0.327 |
| Sepsis,n(%) | 3(3.1) | 3(1.9) | 0.676 |
| UTI,n(%) | 4(4.1) | 1(0.6) | 0.070 |
| MedianLOS(IQR),days | 8 (5) | 7(5) | 0.008 |
| 30-day readmission,n(%) | 16(16.5) | 31(19.5) | 0.547 |
| 30-day RTOR,n(%) | 14(14.4) | 25(15.7) | 0.780 |
Introduction: Limited literature exists evaluating the differences in efficacy between laparoscopic and open proctocolectomy with ileal-pouch anal anastomosis (IPAA) among pediatric patients. We hypothesized that patients undergoing a laparoscopic IPAA would have superior short-term outcomes compared to an open IPAA due to the accepted benefits of minimally-invasive surgery(MIS).
Methods: Using the ACS-NSQIP pediatric PUF [2012-2015], we identified patients (<18years) that underwent laparoscopic or open IPAA. The association of laparoscopic MIS (with respect to open surgery) with 30-day perioperative outcomes [superficial, deep and organ SSI, sepsis, UTI, length of hospital-stay (LOS), readmission and Return-to-OR (RTOR)] was investigated using multivariable regression techniques.
Results: A total of 256 pediatric patients (median age: 13 years, 52% female, Caucasian 84%, ASA I/II 68%) underwent IPAA (laparoscopic:62%; open:38%), with no significant differences in demographic and clinical characteristics across the two groups. In terms of outcomes, patients undergoing laparoscopic IPAA had significantly fewer superficial SSIs(1.9% vs 8.2%; p=0.023) and a shorter median LOS (7 vs 8 days; p=0.008). All other outcomes were not significantly different [Table-1].
In multivariable models adjusted for confounders, patients undergoing laparoscopic IPAA had a lower likelihood of developing superficial SSI compared to open IPAA (OR:0.16; 95%CI:0.03-0.83;p=0.029). However, no significant differences were noted across the two approaches for sepsis, UTI, median LOS, 30-day readmission and RTOR rates in multivariable models (Figure-1). In a subset analysis, older age (OR:1.18; 95% CI:1.04-1.33; p=0.010) and increased operative duration (OR:1.02; 95% CI:1.01-1.04; p=0.041) were associated with an increased risk of 30-day readmission.
Conclusions: Most of the perceived benefits of a MIS on perioperative outcomes were not objectively validated. Laparoscopic IPAA in the pediatric population has similar short-term perioperative outcomes compared to patient undergoing open IPAA except for superficial SSI.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88384
Program Number: P204
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster