Hand-assisted laparoscopic vs open colectomy: an assessment from the American College of Surgeons National Surgical Quality Improvement Program procedure-targeted cohort - 22/10/16
Abstract |
Background |
Perioperative outcomes of patients who underwent hand-assisted colorectal laparoscopic (HALS) vs open colectomy were compared using recently released procedure-targeted database.
Methods |
Review was conducted using the 2012 colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database. Patients were classified into 2 groups according to final surgical approach: HALS vs open (planned). Groups were matched (1:1) based on age, gender, body mass index, surgical procedure, diagnosis, American Society of Anesthesiologists score, and wound classification. Multivariate logistic regression analysis was conducted for group comparison.
Results |
Of 7,303 patients, 1,740 patients were matched in each group. Open group had higher proportion of patients with preoperative dyspnea (P = .01), ascites (P = .01), weight loss (P < .001), smoking history (P = .04), and increased work relative value units (P < .001). After adjusting for difference in baseline comorbidities, overall morbidity, superficial, deep, and organ-space surgical site infection, urinary tract infection, ileus, reoperation, readmission, and hospital stay were significantly higher in open group (P < .05).
Conclusions |
National Surgical Quality Improvement Program targeted-data demonstrated several advantages of HALS compared with open colonic resection including shorter hospital stay and lower complication rate. Further adoption of HALS technique as a bridge to straight laparoscopy or tool in difficult cases can positively impact the short-term outcomes after colectomy when compared with open technique.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Outcomes of HALS and open colectomy were compared using procedure-targeted database. |
• | NSQIP data demonstrated several advantages of HALS compared with open colectomy. |
• | Elective HALS colectomy maintains advantages of straight laparoscopy over open. |
• | HALS provides additional benefit over open surgery for complex colorectal diseases. |
• | Our study supports benefits of HALS as initial approach or bridge to laparoscopy. |
Keywords : Colorectal surgery, NSQIP, Procedure-targeted database, Hand-assisted laparoscopic surgery
Plan
| There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs. |
|
| The authors declare no conflicts of interest. |
Vol 212 - N° 5
P. 808-813 - novembre 2016 Retour au numéro
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