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01-02-2013 | Original Article

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

Authors: Celeste Y. Kang, Wissam J. Halabi, Obaid O. Chaudhry, Vinh Nguyen, Noor Ketana, Joseph C. Carmichael, Alessio Pigazzi, Michael J. Stamos, Steven Mills

Published in: Journal of Gastrointestinal Surgery | Issue 2/2013

Abstract

Background

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.

Study Design

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.

Results

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.

Conclusions

Laparoscopy in high-risk colorectal patients is safe and may demonstrate advantages compared to open surgery.

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Title: A Nationwide Analysis of Laparoscopy in High-Risk Colorectal Surgery Patients
Authors: Celeste Y. Kang
Wissam J. Halabi
Obaid O. Chaudhry
Vinh Nguyen
Noor Ketana
Joseph C. Carmichael
Alessio Pigazzi
Michael J. Stamos
Steven Mills
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 2/2013
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-012-2096-y

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Study Design

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Study Design

Results

Conclusions

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