A Nationwide Analysis of Laparoscopy in High-Risk Colorectal Surgery Patients

作者：Kang Celeste Y; Halabi Wissam J; Chaudhry Obaid O; Vinh Nguyen; Ketana Noor; Carmichael Joseph C; Pigazzi Alessio; Stamos Michael J; Mills Steven^*

来源：Journal of Gastrointestinal Surgery, 2013, 17(2): 382-391.

DOI：10.1007/s11605-012-2096-y

• Laparoscopic
• Colorectal surgery
• High risk
• Nationwide inpatient sample
• Colon cancer
• Rectal cancer
• Colorectal polyps
• Diverticular disease
• Diverticulitis

Due to safety concerns, the use of laparoscopy in high-risk colorectal surgery patients has been limited. Small reports have demonstrated the benefit of laparoscopy in this population; however, large comparative studies are lacking.
A retrospective review of the Nationwide Inpatient Sample 2009 was conducted. Patients undergoing elective colorectal resections for benign and malignant pathology were included in the high-risk group if they had at least two of the following criteria: age > 70, obesity, smoking, anemia, congestive heart failure, valvular disease, diabetes mellitus, chronic pulmonary, kidney and liver disease. Using multivariate logistic regression, the outcomes of laparoscopic surgery were compared to open and converted surgery.
Of 145,600 colorectal surgery cases, 32.79% were high-risk. High-risk patients had higher mortality, hospital charges, and longer hospital stay compared to low-risk patients. The use of laparoscopy was lower in the high-risk group with higher conversion rates. In high-risk patients, compared to open surgery, laparoscopy was associated with lower mortality (OR = 0.60), shorter hospital stay, lower charges, decreased respiratory failure (OR = 0.53), urinary tract infection (OR = 0.64), anastomotic leak (OR = 0.69) and wound complications (OR = 0.46). Conversion to open surgery was not associated with higher mortality.
Laparoscopy in high-risk colorectal patients is safe and may demonstrate advantages compared to open surgery.

• 出版日期2013-2