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Surgical Endoscopy
Published in: Surgical Endoscopy 7/2012

01-07-2012

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

Authors: Venkata R. Kakarla, Steven J. Nurkin, Saurab Sharma, Dan E. Ruiz, Howard Tiszenkel

Published in: Surgical Endoscopy | Issue 7/2012

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Abstract

Background

The benefits of laparoscopic (LC) versus open (OC) colectomy for symptomatic colonic diverticulosis as an elective operation remain unclear.

Methods

Using the American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) participant-user file, patients were identified who underwent elective colon resection for symptomatic colonic diverticulosis, between 2005 and 2008. Demographic, clinical, intraoperative variables, and 30-day morbidity and mortality were collected. Logistic regression analysis was performed to determine the association between the surgical approach (LC vs. OC) and risk-adjusted overall mortality, overall morbidity, serious morbidity, and wound complications.

Results

A total of 7,629 patients were identified who underwent colon resection for symptomatic diverticulosis. They were subdivided into two groups: OC (3,870 (50.7%)) and LC (3,759 (49.3%)). Patients who underwent OC were significantly older (59.0 vs. 55.7 years, P < 0.0001) with more comorbidities compared with those who underwent LC. After risk-adjusted analysis, it was noted that the patients treated with LC were significantly less likely to experience overall morbidity (11.9% vs. 23.2%), serious morbidity (4.6% vs. 10.9%), and wound complications (9.1% vs. 17.5%), but not mortality (0.3% vs. 0.8%). Operative duration was significantly longer with LC (176.64 vs. 166.70 min, P < 0.0001), but the length of stay was significantly shorter (4.77 vs. 7.68 days, P < 0.0001). Using logistic regression analysis, patients with history of peripheral vascular disease, percutaneous coronary interventions, current steroid use, and hypertension requiring medication were at an increased risk of morbidity and mortality at 30 days. Patients with history of chronic obstructive pulmonary disease and smoking experienced more wound complications at 30 days.

Conclusions

In the elective setting for symptomatic diverticulosis, LC seems to be associated with lower 30-day morbidity and complication rates compared with OC.
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Metadata
Title
Elective laparoscopic versus open colectomy for diverticulosis: an analysis of ACS-NSQIP database
Authors
Venkata R. Kakarla
Steven J. Nurkin
Saurab Sharma
Dan E. Ruiz
Howard Tiszenkel
Publication date
01-07-2012
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 7/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-011-2142-y

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