Elective laparoscopic versus open colectomy for diverticulosis: an analysis of ACS-NSQIP database

Kakarla, Venkata R.; Nurkin, Steven; Sharma, Sam; Ruiz, Dan; Tiszenkel, Howard

doi:10.1007/s00464-011-2142-y

Cited by 19 publications

(13 citation statements)

References 23 publications

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“…Multiple studies 24-27 have demonstrated that laparoscopic colon and rectal resections result in decreased complication rates as compared with open resection. In addition to decreased complications, patients who undergo laparoscopic colon and rectal resections have been shown to have shorter postoperative length of stay and improved overall and cancer free survival as compared with open resections, which may make the patients who have had open resections in the past better candidates for laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…25, 26, 30 However, interpreting results from these retrospective reviews is difficult as patients were offered laparoscopic versus open resection according to surgeon preference and historically laparoscopic surgery has been offered to earlier stage cancer patients at larger urban hospitals and younger patients with less comorbidities. 25-27 Therefore, it is difficult to ascertain if patients who undergo laparoscopic procedures have better outcomes due to the operative approach or because they were healthier with earlier stage disease preoperatively. Future studies comparing patients with similar comorbidities and cancer stage who receive laparoscopic versus open procedures as well as studies assessing why surgeons recommend laparoscopic versus open procedures would provide much needed clarification on this topic.…”

Section: Discussionmentioning

confidence: 99%

“…Others have done similar work using SEER-Medicare, NIS and NSQIP data 25-27 and demonstrated significantly decreased rates of postoperative complications in patients who undergo laparoscopic versus open colorectal surgery. An analysis of patients ≥65 years of age using the SEER-Medicare database revealed decreased complication rates in patients who underwent laparoscopic colectomy versus open colectomy for colon cancer (21.5% versus 26.3%).…”

Section: Preoperative Risk Factorsmentioning

confidence: 92%

“…The overall 30 day morbidity in patients who had laparoscopic colectomy was significantly lower than open colectomy patients (11.9% versus 23.2%). 27 …”

Section: Preoperative Risk Factorsmentioning

confidence: 99%

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Postoperative complications and implications on patient-centered outcomes

Tevis

Kennedy

2013

Journal of Surgical Research

153

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Background Postoperative complications increase patient morbidity and mortality and are a target for quality improvement programs. The goal of this study was to review the world's literature on postoperative complications in general surgery patients and to try to examine the effect of these complications on patient-centered outcomes. Methods A comprehensive search of the current literature identified 18 studies on the topic of postoperative complications in general surgery patients. Results Postoperative complications are common in general surgery patients and contribute to increased mortality, length of stay and need for an increased level of care at discharge (decline in disposition). Conclusions While the concept of patient-centered outcomes is not new, it has not been applied to postoperative complications. It is likely that the effect of complications on length of hospital stay and postoperative discharge reflects an impact of complications on these patient-centered outcomes. Future studies should consider the effect of complications on those outcomes that are most important to the individual patient.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Preoperative Risk Factorsmentioning

confidence: 92%

“…The overall 30 day morbidity in patients who had laparoscopic colectomy was significantly lower than open colectomy patients (11.9% versus 23.2%). 27 …”

Section: Preoperative Risk Factorsmentioning

confidence: 99%

See 2 more Smart Citations

Postoperative complications and implications on patient-centered outcomes

Tevis

Kennedy

2013

Journal of Surgical Research

153

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“…For non-oncologic resections, similar results have been reported. Retrospective studies evaluating elective colectomy for diverticulosis and randomized trials such as the SIGMA have reported a significant reduction in postoperative morbidity with a minimally invasive approach[5,6]. Unfortunately, clinical trials in laparoscopic surgery have underrepresented the elderly and fail to account for frailty[7,8].…”

Section: Introductionmentioning

confidence: 99%

Impact of frailty on approach to colonic resection: Laparoscopy vs open surgery

Mosquera¹,

Spaniolas²,

Fitzgerald³

2016

WJG

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AIMTo understand the influence of frailty on postoperative outcomes for laparoscopic and open colectomy.METHODSData were obtained from the National Surgical Quality Improvement Program (2005-2012) for patients undergoing colon resection [open colectomy (OC) and laparoscopic colectomy (LC)]. Patients were classified as non-frail (0 points), low frailty (1 point), moderate frailty (2 points), and severe frailty (≥ 3) using the Modified Frailty Index. 30-d mortality and complications were used as the primary end point and analyzed for the overall population. Complications were grouped into major and minor. Subset analysis was performed for patients undergoing colectomy (total colectomy, partial colectomy and sigmoid colectomy) and separately for patients undergoing rectal surgery (abdominoperineal resection, low anterior resection, and proctocolectomy). We analyzed the data using SAS Platform JMP Pro version 10.0.0 (SAS Institute Inc., Cary, NC, United States).RESULTSA total of 94811 patients were identified; the majority underwent OC (58.7%), were white (76.9%), and non-frail (44.8%). The median age was 61.3 years. Prolonged length of stay (LOS) occurred in 4.7%, and 30-d mortality was 2.28%. Patients undergoing OC were older (61.89 ± 15.31 vs 60.55 ± 14.93) and had a higher ASA score (48.3% ASA3 vs 57.7% ASA2 in the LC group) (P < 0.0001). Most patients were non-frail (42.5% OC vs 48% LC, P < 0.0001). Complications, prolonged LOS, and mortality were significantly more common in patients undergoing OC (P < 0.0001). OC had a higher risk of death and complications compared to LC for all frailty scores (non-frail: OR = 4.7, and OR = 4.67; mildly frail: OR = 2.51, and OR = 2.47; moderately frail: OR = 2.94, and OR = 2.02, severely frail: OR = 2.37, and OR = 2.34, P < 0.05) and an increase in absolute mortality with increasing frailty (non-frail 0.68% OC, mildly frail 1.39%, moderately frail 3.44%, and severely frail 5.83%, P < 0.0001).CONCLUSIONLC is associated with improved outcomes. Although the odds of mortality are higher in non-frail, there is a progressive increase in mortality with increasing frailty.

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Cost of Medical Care: Whose Money Are We Talking About?

Senagore

2015

Pelvic Cancer Surgery

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Elective laparoscopic versus open colectomy for diverticulosis: an analysis of ACS-NSQIP database

Abstract: In the elective setting for symptomatic diverticulosis, LC seems to be associated with lower 30-day morbidity and complication rates compared with OC.

Cited by 19 publications

References 23 publications

Postoperative complications and implications on patient-centered outcomes

Postoperative complications and implications on patient-centered outcomes

Impact of frailty on approach to colonic resection: Laparoscopy vs open surgery

Cost of Medical Care: Whose Money Are We Talking About?

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