Effects of laparoscopic vs open abdominal surgery on costs and hospital readmission rate and its effect modification by surgeons’ case volume

Shin, Taehoon; Friedrich, Sabine; Brat, Gabriel; Rudolph, Maíra I.; Sein, Vicki; Munoz-Acuna, Ronny; Houle, Timothy T.; Ferrone, Cristina R.; Eikermann, Matthias

doi:10.1007/s00464-019-07222-x

Cited by 12 publications

(5 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition to wound protection, a plastic wound protector also enhances surgical field visibility by retracting the incision site. Despite the rise of minimally invasive techniques that contribute to the reduction of SSI, many patients still require open GI surgery . A self-retaining plastic wound retractor, designed for smaller incisions but wider operative views, was shown to significantly shorten incision lengths in 2 studies .…”

Section: Discussionmentioning

confidence: 99%

Plastic Wound Protector vs Surgical Gauze for Surgical Site Infection Reduction in Open GI Surgery

Yoo,

Mun,

Kye

et al. 2024

JAMA Surg

View full text Add to dashboard Cite

ImportanceSurgical site infections (SSIs) are prevalent hospital-acquired infections with significant patient impacts and global health care burdens. The World Health Organization recommends using wound protector devices in abdominal surgery as a preventive measure to lower the risk of SSIs despite limited evidence.ObjectiveTo examine the efficacy of a dual-ring, plastic wound protector in lowering the SSI rate in open gastrointestinal (GI) surgery irrespective of intra-abdominal contamination levels.Design, Setting, and ParticipantsThis multicenter, patient-blinded, parallel-arm randomized clinical trial was conducted from August 2017 to October 2022 at 13 hospitals in an academic setting. Patients undergoing open abdominal bowel surgery (eg, for bowel perforation) were eligible for inclusion.InterventionPatients were randomized 1:1 to a dual-ring, plastic wound protector to protect the incision site of the abdominal wall (experimental group) or a conventional surgical gauze (control group).Main Outcomes and MeasuresThe primary end point was the rate of SSI within 30 days of open GI surgery.ResultsA total of 458 patients were randomized; after 1 was excluded from the control group, 457 were included in the intention-to-treat analysis (mean [SD] age, 58.4 [12.1] years; 256 [56.0%] male; 341 [74.6%] with a clean-contaminated wound): 229 in the wound protector group and 228 in the surgical gauze group. The overall SSI rate in the intention-to-treat analysis was 15.7% (72 of 458 patients). The SSI rate for the wound protector was 10.9% (25 of 229 patients) compared with 20.5% (47 of 229 patients) with surgical gauze. The wound protector significantly reduced the risk of SSI, with a relative risk reduction (RRR) of 46.81% (95% CI, 16.64%-66.06%). The wound protector significantly decreased the SSI rate for clean-contaminated wounds (RRR, 43.75%; 95% CI, 3.75%-67.13%), particularly for superficial SSIs (RRR, 42.50%; 95% CI, 7.16%-64.39%). Length of hospital stay was similar in both groups (mean [SD], 15.2 [10.5] vs 15.3 [10.2] days), as were the overall postoperative complication rates (20.1% vs 18.8%).Conclusions and RelevanceThis randomized clinical trial found a significant reduction in SSI rates when a plastic wound protector was used during open GI surgery compared with surgical gaze, supporting the World Health Organization recommendation for use of wound protector devices in abdominal surgery.Trial RegistrationClinicalTrials.gov Identifier: NCT03170843

show abstract

Section: Discussionmentioning

confidence: 99%

Plastic Wound Protector vs Surgical Gauze for Surgical Site Infection Reduction in Open GI Surgery

Yoo,

Mun,

Kye

et al. 2024

JAMA Surg

View full text Add to dashboard Cite

show abstract

“…Laparoscopy was followed by significantly lower rates of readmissions related to gastrointestinal, wound complications and malignancy [34]. For elderly patients with periampullary tumors, LPD might be an alternative surgical option [35].…”

Section: Discussionmentioning

confidence: 99%

“…On the other side, the laparoscopic procedure has some drawbacks, including prolonged operation time and impact of carbon dioxide pneumoperitoneum on circulatory and respiratory dynamics [35]. Although laparoscopy is minimally invasive in its dissection techniques, its physiology might lead to acidosis, produce changes in pulmonary mechanics, induce alteration in hemodynamic function and increase the risk of aspiration.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Laparoscopic Pancreatoduodenectomy in Elderly Patients: A Systematic Review and Meta-Analysis

Bartoș

Mărgărit

Bocse

et al. 2022

Life

View full text Add to dashboard Cite

Background and Aims: Recent single-center retrospective studies have focused on laparoscopic pancreatoduodenectomy (LPD) in elderly patients, and compared the outcomes between the laparoscopic and open approaches. Our study aimed to determine the outcomes of LPD in the elderly patients, by performing a systematic review and a meta-analysis of relevant studies. Methods: A comprehensive literature review was conducted utilizing the Embase, Medline, PubMed, Scopus and Cochrane databases to identify all studies that compared laparoscopic vs. open approach for pancreatoduodenectomy (PD). Results: Five retrospective studies were included in the final analysis. Overall, 90-day mortality rates were significantly decreased after LPD in elderly patients compared with open approaches (RR = 0.56; 95%CI: 0.32–0.96; p = 0.037, I2 = 0%). The laparoscopic approach had similar mortality rate at 30-day, readmission rate in hospital, Clavien–Dindo complications, pancreatic fistula grade B/C, complete resection rate, reoperation for complications and blood loss as the open approach. Additionally, comparing with younger patients (<70 years old), no significant differences were seen in elderly cohort patients regarding mortality rate at 90 days, readmission rate to hospital, and complication rate. Conclusions: Based on our meta-analysis, we identify that LPD in elderly is a safe procedure, with significantly lower 90-day mortality rates when compared with the open approach. Our results should be considered with caution, considering the retrospective analyses of the included studies; larger prospective studies are required.

show abstract

“…Laparoscopic colorectal resection is associated with better overall outcomes, including: lower frequency of blood transfusions and surgical site infections and decreased rates of readmission and mortality. 46,47,48,49 Additionally, the laparoscopic approach for colon resection has also been shown to result in an 11.3% reduction in postoperative ileus and a shorter length of stay when compared with open surgery. 49 Our finding that Black patients are less likely to receive laparoscopic surgery, when compared to White patients, may contribute to the observed disparities in surgical outcomes and colorectal cancer outcomes, in general.…”

Section: Laparoscopic Versus Open Colorectal Cancer Surgerymentioning

confidence: 99%

Colorectal Cancer Disparities Across the Continuum of Cancer Care: A Systematic Review and Meta-Analysis

Syvyk

Wirtalla

Kelz

et al. 2021

Preprint

View full text Add to dashboard Cite

IMPORTANCE Colorectal Cancer (CRC) disparities continue to mostly impact vulnerable populations. Across the CRC continuum, most focus has been attributed to interventions in prevention, detection, and diagnosis. Varying surgical outcomes has emerged as an important contributing factor to CRC disparities. OBJECTIVE To evaluate the distribution of publications across the CRC care continuum, examine interventional studies related to CRC Surgery, and synthesize findings in studies evaluating CRC disparities in Surgery. DATA SOURCES We searched PubMed for prospective or retrospective studies reporting data on colorectal cancer disparities. STUDY SELECTION Studies were selected if: (1) articles used US-sourced data (2) articles were published in the English language (3) Subjects included humans only or data. MAIN OUTCOMES AND MEASURES Odds ratios for receipt of surgery for black vs. white patients were pooled from studies that performed multivariate analysis. Subgroup analysis was performed per procedure type. RESULTS No publications regarding interventions associated with improvements in colorectal cancer surgery were found. Of the 1600 articles identified, an analysis was conducted from 18 publications. It included 89,214 black patients and 646,990 white patients. Black patients were significantly less likely to receive surgical treatment for CRC than white patients. This was confirmed in the sensitivity analysis by cancer site (colon vs rectum). CONCLUSIONS AND RELEVANCE Based on the results, the majority of studies on CRC disparities have focused on access to prevention, diagnosis and screening. Considering the impact of varying surgical outcomes on vulnerable populations, it should be considered to shift research focus from process-oriented interventions to outcomes.

show abstract

Effects of laparoscopic vs open abdominal surgery on costs and hospital readmission rate and its effect modification by surgeons’ case volume

Cited by 12 publications

References 61 publications

Plastic Wound Protector vs Surgical Gauze for Surgical Site Infection Reduction in Open GI Surgery

Plastic Wound Protector vs Surgical Gauze for Surgical Site Infection Reduction in Open GI Surgery

Laparoscopic Pancreatoduodenectomy in Elderly Patients: A Systematic Review and Meta-Analysis

Colorectal Cancer Disparities Across the Continuum of Cancer Care: A Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About