Authors: Deborah S Keller Rodrigo Pedraza Juan Ramon FloresGonzalez Jean Paul LeFave Ali Mahmood Eric M Haas
Publish Date: 2015/10/21
Volume: 30, Issue: 8, Pages: 3321-3326
Abstract
Populationbased studies evaluating laparoscopic colectomy and outcomes compared with open surgery have concentrated on elective resections As such data assessing nonelective laparoscopic colectomies are limited Our goal was to evaluate the current usage and outcomes of laparoscopic in the urgent and emergent setting in the USAA national inpatient database was reviewed from 2008 to 2011 for right left and sigmoid colectomies in the nonelective setting Cases were stratified by approach into open or laparoscopic groups Demographics perioperative clinical variables and financial outcomes were compared across each groupA total of 22719 nonelective colectomies were analyzed The vast majority 958 was open Most cases were performed in an urban setting at nonteaching hospitals by general surgeons Colorectal surgeons were significantly more likely to perform a case laparoscopic than general surgeons p 0001 Demographics were similar between open and laparoscopic groups however the disease distribution by approach varied with significantly more severe cases in the open colectomy arm p 0001 Cases performed laparoscopically had significantly better mortality and complication rates Laparoscopic cases also had significantly improved outcomes including shorter length of stay and hospital costs all p 0001Our analysis revealed less than 5 of urgent and emergent colectomies in the USA are performed laparoscopically Colorectal surgeons were more likely to approach a case laparoscopically than general surgeons Outcomes following laparoscopic colectomy in this setting resulted in reduced length of stay lower complication rates and lower costs Increased adoption of laparoscopy in the nonelective setting should be considered
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