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01-06-2022 | Laparoscopy

Laparoscopy is associated with decreased all-cause mortality in patients undergoing emergency general surgery procedures in a regional health system

Authors: Sean J. Donohue, Caroline E. Reinke, Susan L. Evans, Mary M. Jordan, Yancey E. Warren, Timothy Hetherington, Marc Kowalkowski, Addison K. May, Brent D. Matthews, Samuel W. Ross

Published in: Surgical Endoscopy | Issue 6/2022

Abstract

Background

The aim of this study was to evaluate the use of laparoscopic surgery for common emergency general surgery (EGS) procedures within an integrated Acute Care Surgery (ACS) network. We hypothesized that laparoscopy would be associated with improved outcomes.

Methods

Our integrated health care system’s EGS registry created from AAST EGS ICD-9 codes was queried from January 2013 to October 2015. Procedures were grouped as laparoscopic or open. Standard descriptive and univariate tests were performed, and a multivariable logistic regression controlling for open status, age, BMI, Charlson Comorbidity Index (CCI), trauma tier, and resuscitation diagnosis was performed. Laparoscopic procedures converted to open were identified and analyzed using concurrent procedure billing codes across episodes of care.

Results

Of 60,604 EGS patients identified over the 33-month period, 7280 (12.0%) had an operation and 6914 (11.4%) included AAST-defined EGS procedures. There were 4813 (69.6%) surgeries performed laparoscopically. Patients undergoing a laparoscopic procedure tended to be younger (45.7 ± 18.0 years vs. 57.2 ± 17.6, p < 0.001) with similar BMI (29.7 ± 9.0 kg/m² vs. 28.8 ± 8.3, p < 0.001). Patients in the laparoscopic group had lower mean CCI score (1.6 ± 2.3 vs. 3.4 ± 3.2, p ≤ 0.0001). On multivariable analysis, open surgery had the highest association with inpatient mortality (OR 8.67, 4.23–17.75, p < 0.0001) and at all time points (30-, 90-day, 1-, 3-year). At all time points, conversion to open was found to be a statistically significant protective factor.

Conclusion

Use of laparoscopy in EGS is common and associated with a decreased risk of all-cause mortality at all time points compared to open procedures. Conversion to open was protective at all time points compared to open procedures.

Britt LD (2012) Acute care surgery: what’s in a name? J Trauma Acute Care Surg 72:319–320. https://doi.org/10.1097/TA.0b013e31824b15c1CrossRefPubMed

Britt LD (2012) American association for the surgery of trauma and the clinical congress of acute care surgery 2011 presidential address. J Trauma Acute Care Surg 72:4–10. https://doi.org/10.1097/TA.0b013e31823fbda3CrossRefPubMed

Morris JA, Fildes J, May AK, Diaz J, Britt LD, Meredith JW (2013) A research agenda for emergency general surgery: health policy and basic science. J Trauma Acute Care Surg 74:322–328. https://doi.org/10.1097/TA.0b013e31827d0fe3CrossRefPubMed

Morris JA, Diaz J, Fildes J, May AK, Britt LD, Meredith JW (2013) A research agenda for emergency general surgery: clinical trials. J Trauma Acute Care Surg 74:329–333. https://doi.org/10.1097/TA.0b013e31827542cdCrossRefPubMed

Shafi S, Aboutanos MB, Agarwal S, Brown CVR, Crandall M, Feliciano DV, Guillamondegui O, Haider A, Inaba K, Osler TM, Ross S, Rozycki GS, Tominaga GT (2013) Emergency general surgery: definition and estimated burden of disease. J Trauma Acute Care Surg 74:1092–1097. https://doi.org/10.1097/TA.0b013e31827e1bc7CrossRefPubMed

Gale SC, Shafi S, Dombrovskiy VY, Arumugam D, Crystal JS (2014) The public health burden of emergency general surgery in the United States: a 10-year analysis of the Nationwide Inpatient Sample—2001 to 2010. J Trauma Acute Care Surg 77:202–208. https://doi.org/10.1097/TA.0000000000000362CrossRefPubMed

Havens JM, Olufajo OA, Cooper ZR, Haider AH, Shah AA, Salim A (2016) Defining rates and risk factors for readmissions following emergency general surgery. JAMA Surg 151:330–336. https://doi.org/10.1001/jamasurg.2015.4056CrossRefPubMed

Shah AA, Haider AH, Zogg CK, Schwartz DA, Haut ER, Zafar SN, Schneider EB, Velopulos CG, Shafi S, Zafar H, Efron DT (2015) National estimates of predictors of outcomes for emergency general surgery. J Trauma Acute Care Surg 78:482–491. https://doi.org/10.1097/TA.0000000000000555CrossRefPubMed

Scott JW, Olufajo OA, Brat GA, Rose JA, Zogg CK, Haider AH, Salim A, Havens JM (2016) Use of national burden to define operative emergency general surgery. JAMA Surg 151:1–7. https://doi.org/10.1001/jamasurg.2016.0480CrossRef

10.

Ingraham AM, Cohen ME, Raval MV, Ko CY, Nathens AB (2011) Comparison of hospital performance in emergency versus elective general surgery operations at 198 hospitals. J Am Coll Surg 212:20-28.e1. https://doi.org/10.1016/j.jamcollsurg.2010.09.026CrossRefPubMed

11.

McCoy CC, Englum BR, Keenan JE, Vaslef SN, Shapiro ML, Scarborough JE (2015) Impact of specific postoperative complications on the outcomes of emergency general surgery patients. J Trauma Acute Care Surg 78:912–919. https://doi.org/10.1097/TA.0000000000000611CrossRefPubMed

12.

Ogola GO, Gale SC, Haider A, Shafi S (2015) The financial burden of emergency general surgery: national estimates 2010 to 2060. J Trauma Acute Care Surg 79:444–448. https://doi.org/10.1097/TA.0000000000000787CrossRefPubMed

13.

Hall EC, Hashmi ZG, Zafar SN, Zogg CK, Cornwell EE, Haider AH (2015) Racial/ethnic disparities in emergency general surgery: explained by hospital-level characteristics? Am J Surg 209:604–609. https://doi.org/10.1016/j.amjsurg.2014.11.005CrossRefPubMed

14.

Eckert M, Cuadrado D, Steele S, Brown T, Beekley A, Martin M (2010) The changing face of the general surgeon: national and local trends in resident operative experience. Am J Surg 199:652–656. https://doi.org/10.1016/j.amjsurg.2010.01.012CrossRefPubMed

15.

Malangoni MA, Biester TW, Jones AT, Klingensmith ME, Lewis FR (2013) Operative experience of surgery residents: trends and challenges. J Surg Educ 70:783–788. https://doi.org/10.1016/j.jsurg.2013.09.015CrossRefPubMed

16.

Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47:1245–1251. https://doi.org/10.1016/0895-4356(94)90129-5CrossRefPubMed

17.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 40:373–383. https://doi.org/10.1016/0021-9681(87)90171-8CrossRefPubMed

18.

Agresta F, Campanile FC, Podda M, Cillara N, Pernazza G, Giaccaglia V, Ciccoritti L, Ioia G, Mandalà S, La Barbera C, Birindelli A, Sartelli M, Di Saverio S, Anania G, Vettoretto N, Arezzo A, Campli M, Bergamini C, Carlucci M, Zago M, Mirabella A, Lupo M, Piccoli M, Ansaloni L, Cocorullo G, Baiocchi L, Allaix M, Saia M, Luridiana G (2017) Current status of laparoscopy for acute abdomen in Italy: a critical appraisal of 2012 clinical guidelines from two consecutive nationwide surveys with analysis of 271,323 cases over 5 years. Surg Endosc 31:1785–1795. https://doi.org/10.1007/s00464-016-5175-4CrossRefPubMed

19.

Johnson B, Bogert J, Dennis B, Fox N, Gunter O, Sawhney J, Schroeder L, Yeh DD, Young J (2020) Role of laparoscopy in small bowel obstruction 2018. In: East. Assoc. Surg. Trauma. https://www.east.org/education/practice-management-guidelines/details/64/role-of-laparoscopy-in-small-bowel-obstruction. Accessed 1 Oct 2020

20.

Pansa A, Kurihara H, Memon MA (2020) Updates in laparoscopic surgery for perforated peptic ulcer disease: state of the art and future perspectives. Ann Laparosc Endosc Surg 5:5. https://doi.org/10.21037/ales.2019.11.03CrossRef

21.

Rodriguez RMJ, Segura-Sampedro JJ, Flores-Cortés M, López-Bernal F, Martín C, Diaz VP, Ciuro FP, Ruiz JP (2016) Laparoscopic approach in gastrointestinal emergencies. World J Gastroenterol 22:2701–2710. https://doi.org/10.3748/wjg.v22.i9.2701CrossRef

22.

Mandrioli M, Inaba K, Piccinini A, Biscardi A, Sartelli M, Agresta F, Catena F, Cirocchi R, Jovine E, Tugnoli G, Di Saverio S (2016) Advances in laparoscopy for acute care surgery and trauma. World J Gastroenterol 22:668–680. https://doi.org/10.3748/wjg.v22.i2.668CrossRefPubMedPubMedCentral

23.

Richards MK, McAteer JP, Drake FT, Goldin AB, Khandelwal S, Gow KW (2015) A national review of the frequency of minimally invasive surgery among general surgery residents. JAMA Surg 150:169. https://doi.org/10.1001/jamasurg.2014.1791CrossRefPubMed

24.

McCoy AC, Gasevic E, Szlabick RE, Sahmoun AE, Sticca RP (2013) Are open abdominal procedures a thing of the past? An analysis of graduating general surgery residents’ case logs from 2000 to 2011. J Surg Educ 70:683–689. https://doi.org/10.1016/j.jsurg.2013.09.002CrossRefPubMed

25.

Brown NM, Helmer SD, Yates CL, Osland JS (2012) The revised ACGME laparoscopic operative requirements: How have they impacted resident education? Surg Endosc 26:1737–1743. https://doi.org/10.1007/s00464-011-2103-5CrossRefPubMed

26.

Zerey M, Heniford BT (2006) Laparoscopic versus open surgery for ventral hernia repair: Which is best? Commentary. Nat Clin Pract Gastroenterol Hepatol 3:372–373. https://doi.org/10.1038/ncpgasthep0548CrossRefPubMed

27.

Rosen MJ, Cobb WS, Kercher KW, Heniford BT (2006) Laparoscopic versus open colostomy reversal: A comparative analysis. J Gastrointest Surg 10:895–900. https://doi.org/10.1016/j.gassur.2005.11.008CrossRefPubMed

28.

Giordano S, Victorzon M (2014) Laparoscopic Roux-En-Y gastric bypass is effective and safe in over 55-year-old patients: a comparative analysis. World J Surg 38:1121–1126. https://doi.org/10.1007/s00268-013-2399-5CrossRefPubMed

29.

Tyson AF, Sola R, Arnold MR, Cosper GH, Schulman AM (2017) Thoracoscopic versus open congenital diaphragmatic hernia repair: single tertiary center review. J Laparoendosc Adv Surg Tech 27:1209–1216. https://doi.org/10.1089/lap.2017.0298CrossRef

30.

Sauerland S, Agresta F, Bergamaschi R, Borzellino G, Budzynski A, Champault G, Fingerhut A, Isla A, Johansson M, Lundorff P, Navez B, Saad S, Neugebauer EAM (2006) Laparoscopy for abdominal emergencies. Surg Endosc 20:14–29. https://doi.org/10.1007/s00464-005-0564-0CrossRefPubMed

31.

O’Connor DB, Winter DC (2012) The role of laparoscopy in the management of acute small-bowel obstruction: a review of over 2000 cases. Surg Endosc 26:12–17. https://doi.org/10.1007/s00464-011-1885-9CrossRefPubMed

32.

Training Requirements for General Surgery Certification. In: Am. Board Surg. https://www.absurgery.org/default.jsp?certgsqe_training

33.

Bingmer K, Ofshteyn A, Stein SL, Marks JM, Steinhagen E (2020) Decline of open surgical experience for general surgery residents. Surg Endosc 34:967–972. https://doi.org/10.1007/s00464-019-06881-0CrossRefPubMed

34.

Finnerty BM, Wu X, Giambrone GP, Gaber-Baylis LK, Zabih R, Bhat A, Zarnegar R, Pomp A, Fleischut P, Afaneh C (2017) Conversion-to-open in laparoscopic appendectomy: A cohort analysis of risk factors and outcomes. Int J Surg 40:169–175. https://doi.org/10.1016/j.ijsu.2017.03.016CrossRefPubMed

35.

Kaafarani HMA, Smith TS, Neumayer L, Berger DH, DePalma RG, Itani KMF (2010) Trends, outcomes, and predictors of open and conversion to open cholecystectomy in Veterans Health Administration hospitals. Am J Surg 200:32–40. https://doi.org/10.1016/j.amjsurg.2009.08.020CrossRefPubMed

36.

Masoomi H, Moghadamyeghaneh Z, Mills S, Carmichael JC, Pigazzi A, Stamos MJ (2015) Risk factors for conversion of laparoscopic colorectal surgery to open surgery: does conversion worsen outcome? World J Surg 39:1240–1247. https://doi.org/10.1007/s00268-015-2958-zCrossRefPubMed

37.

Yong J, Hibbert P, Runciman WB, Coventry BJ (2015) Bradycardia as an early warning sign for cardiac arrest during routine laparoscopic surgery. Int J Qual Health Care 27:473–478. https://doi.org/10.1093/intqhc/mzv077CrossRefPubMed

38.

Hernandez M, Murphy B, Aho JM, Haddad NN, Saleem H, Zeb M, Morris DS, Jenkins DH, Zielinski M (2018) Validation of the AAST EGS acute cholecystitis grade and comparison with the Tokyo guidelines. Surgery 163:739–746. https://doi.org/10.1016/j.surg.2017.10.041CrossRefPubMed

39.

Sekimoto M, Takada T, Kawarada Y, Nimura Y, Yoshida M, Mayumi T, Miura F, Wada K, Hirota M, Yamashita Y, Strasberg S, Pitt HA, Belghiti J, de Santibanes E, Gadacz TR, Hilvano SC, Kim S-W, Liau K-H, Fan S-T, Belli G, Sachakul V (2007) Need for criteria for the diagnosis and severity assessment of acute cholangitis and cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg 14:11–14. https://doi.org/10.1007/s00534-006-1151-zCrossRefPubMedPubMedCentral

40.

Takada T, Strasberg SM, Solomkin JS, Pitt HA, Gomi H, Yoshida M, Mayumi T, Miura F, Gouma DJ, Garden OJ, Büchler MW, Kiriyama S, Yokoe M, Kimura Y, Tsuyuguchi T, Itoi T, Gabata T, Higuchi R, Okamoto K, Hata J, Murata A, Kusachi S, Windsor JA, Supe AN, Lee SG, Chen X-P, Yamashita Y, Hirata K, Inui K, Sumiyama Y (2013) TG13: Updated Tokyo guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 20:1–7. https://doi.org/10.1007/s00534-012-0566-yCrossRefPubMed

41.

Hussain A (2011) Difficult laparoscopic cholecystectomy: current evidence and strategies of management. Surg Laparosc Endosc Percutaneous Tech 21:211–217. https://doi.org/10.1097/SLE.0b013e318220f1b1CrossRef

42.

Sugrue M, Coccolini F, Bucholc M, Johnston A, Manatakis D, Ioannidis O, Bonilauri S, Gachabayov M, Isik A, Ghnnam W, Shelat V, Aremu M, Mohan R, Montori G, Walȩdziak M, Pisarska M, Kong V, Strzałka M, Fugazzola P, Nita GE, Nardi M, Major P, Negoi I, Allegri A, Konstantoudakis G, Di Carlo I, Massalou D, D’Amico G, Solaini L, Ceresoli M, Bini R, Zielinski M, Tomasoni M, Litvin A, De Simone B, Lostoridis E, Hernandez F, Panyor G, Machain GMV, Pentara I, Baiocchi L, Ng KC, Ansaloni L, Sartelli M, Arellano ML, Savala N, Couse N, McBride S (2019) Intra-operative gallbladder scoring predicts conversion of laparoscopic to open cholecystectomy: a WSES prospective collaborative study. World J Emerg Surg 14:10–17. https://doi.org/10.1186/s13017-019-0230-9CrossRef

43.

Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M, Sugrue M, De Moya M, Gomes CA, Bhangu A, Agresta F, Moore EE, Soreide K, Griffiths E, De Castro S, Kashuk J, Kluger Y, Leppaniemi A, Ansaloni L, Andersson M, Coccolini F, Coimbra R, Gurusamy KS, Campanile FC, Biffl W, Chiara O, Moore F, Peitzman AB, Fraga GP, Costa D, Maier RV, Rizoli S, Balogh ZJ, Bendinelli C, Cirocchi R, Tonini V, Piccinini A, Tugnoli G, Jovine E, Persiani R, Biondi A, Scalea T, Stahel P, Ivatury R, Velmahos G, Andersson R (2016) WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg 11:1–25. https://doi.org/10.1186/s13017-016-0090-5CrossRef

44.

Birkmeyer JD, Reames BN, McCulloch P, Carr AJ, Campbell WB, Wennberg JE (2013) Understanding of regional variation in the use of surgery. Lancet 382:1121–1129. https://doi.org/10.1016/S0140-6736(13)61215-5CrossRefPubMedPubMedCentral

Title: Laparoscopy is associated with decreased all-cause mortality in patients undergoing emergency general surgery procedures in a regional health system
Authors: Sean J. Donohue
Caroline E. Reinke
Susan L. Evans
Mary M. Jordan
Yancey E. Warren
Timothy Hetherington
Marc Kowalkowski
Addison K. May
Brent D. Matthews
Samuel W. Ross
Publication date: 01-06-2022
Publisher: Springer US
Keywords: Laparoscopy
Basic Surgery
Care
Minimally Invasive Surgery
Inguinal Hernia
Published in: Surgical Endoscopy / Issue 6/2022
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-021-08699-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopy is associated with decreased all-cause mortality in patients undergoing emergency general surgery procedures in a regional health system

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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