Michael R Arnold, MD, Lynnette Schiffern, MD, Beverly L Paton, MD, Brent D Matthews, MD, Caroline Reinke, MD. Carolinas Medical Center
Background: Minimally invasive surgery (MIS) has demonstrated superior outcomes in many elective procedures. It’s use in emergency general surgery (EGS) procedures is not well characterized. This study examines trends in utilization and outcomes of MIS techniques in EGS over the past decade.
Methods: The 2007-2016 ACS-NSQIP database was utilized to identify patients undergoing EGS for four common diagnoses: appendicitis, cholecystitis/cholangitis, peptic ulcer disease, and small bowel obstruction. Trends over time were described. Preoperative risk factors, operative characteristics, outcomes, morbidity and trends were compared between MIS and open approaches using univariate and multivariate analysis.
Results: During the study period 190,264 patients were identified. The appendicitis group was the largest(166,559 patients) followed by gallbladder(9,994), bowel obstruction(6,256), and peptic ulcer(366). Utilization of MIS increased over time in all groups (Figure 1). There was a concurrent decrease in mean days of hospitalization in each group; appendectomy (2.4 to 2.0), cholecystectomy (5.7 to 3.2), peptic ulcer (20.3 to 11.7), and bowel obstruction (12.9 to 10.5). When controlling for patient and disease characteristics, MIS techniques were associated with decreased odds of 30-day mortality and length of hospital stay in all groups (Table 1). Similar results were found for surgical site infection, but was not statistically significant in the peptic ulcer disease patients.
Conclusions: Use of MIS techniques in these 4 EGS diagnoses has increased in frequency over the past decade. When adjusted for preoperative risk factors, MIS decreased the odds of wound infection, death, and length of stay. Other confounders may exist that are unable to be adjusted for in the NSQIP data. Further studies to determine if increased access to MIS techniques among EGS patients may improve outcomes are needed.
Table 1: Results of univariate and multivariable regression examining the impact of MIS approaches vs. open approach by diagnosis group
| Appendicitis | Gallbladder disease | Peptic ulcer disease | Small bowel obstrution | ||
| Death | Unadjusted OR | 0.13 | 0.09 | 0.15 | 0.19 |
| Adjusted OR | 0.29 | 0.24 | 0.21 | 0.32 | |
| SSI | Unadjusted OR | 0.31 | 0.19 | 0.65 | 0.14 |
| Adjusted OR | 0.40 | 0.27 | 0.72 | 0.15 | |
| Length of Stay | Unadjusted OR | -5.2 | -7.2 | -5.8 | -2.5 |
| Adjusted OR | -2.0 | -3.9 | -5.2 | -3.7 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95669
Program Number: S143
Presentation Session: Acute Care
Presentation Type: Podium