|
|
Back to 2015 Annual Meeting Program
Laparoscopic Colectomy Is Associated With a Lower Anastomotic Leak Rate Than Open Surgery.
Alice Murray*, David E. Estrada Trejo, Ravi Pasam, Anne-Sophie V. Dalen, Ravi Kiran
Colorectal Surgery, New York Presbyterian, New York City, NY
Background: Anastomotic leak following colorectal surgery is associated with significant morbidity and mortality. There are few large-scale studies evaluating the effect of laparoscopic surgery alone on leak rate.
Methods: The 2012 National Surgical Quality Improvement Program targeted colectomy data were queried for patients who underwent colorectal resections with anastomosis and no ostomy. Patient demographics, pre-operative and operative characteristics were compared for patients who underwent laparoscopic versus open operations and those that did and did not develop an anastomotic leak, according to ACS definitions. Univariable and multivariable analyses were performed to assess the impact of laparoscopy on the development of an anastomotic leak, whilst adjusting for confounders.
Results: Of 14,339 patients, 3.8% developed an anastomotic leak. 8760 patients (61%) underwent laparoscopic surgery with a leak rate of 3.1% (n=272). 39% patients (n=5502) underwent open surgery with a leak rate of 4.9% (n=274)(p<0.0001). Patients who developed a leak were more likely to die within 30 days of surgery (5.7% vs. 2.2% p<0.0001). Patients who underwent laparoscopic surgery compared to open operations were younger (median age 62 vs. 64 years, p=0.001), more likely obese (33.7% ≥30Kg/m2 vs. 31%, p=0.037) and with fewer comorbidities including diabetes, COPD and disseminated cancer (all p<0.05). On univariable analysis laparoscopic surgery was associated with reduced odds of developing an anastomotic leak (OR=0.61 (95% CI: 0.52-0.73), p<.0001). On multivariable analysis, adjusting for all other significant confounders, laparoscopic colectomy was still associated with a lower leak rate (OR=0.65 (95% CI: 0.55-0.79), p<0.0001). Other factors associated with increased odds of leak included male gender, smoking, ASA ≥3, severe COPD, prior sepsis, chronic steroids, hypoalbuminemia, prolonged operative time and emergency surgery (all p<0.05).
Conclusion: Laparoscopic surgery is associated with a significantly lower risk of anastomotic leak in colorectal resections even when controlling for other confounders. This supports the adoption of the technique, when feasible, for most colorectal resections.
Characteristics for Laparoscopic Surgery
| Characteristics | Laparoscopic surgery
(N=8760)
| Open surgery
(N=5502)
| p-value | | Age, median (IQR) | 62 (51-72) | 64 (52-75) | 0.001 | | Sex (male), n (%) | 4248 (48.5) | 2579 (46.9) | 0.061 | | BMI ≥ 30, n (%) | 2942 (33.7) | 1722 (32.0) | 0.037 | | ASA, n (%) | | | <0.0001 | | 2 | 4687 (53.5) | 1971 (35.9) | | | 3 | 3474 (39.7) | 2700 (49.1) | | | Prior sepsis, n (%) | 251 (2.9) | 863 (15.7) | <0.0001 | | Disseminated cancer, n (%) | 255 (2.9) | 532 (9.7) | <0.0001 | | Weight loss (>10% body weight), n (%) | 282 (3.2) | 397 (7.2) | <0.0001 | | Total operation time (≥180 min), n (%) | 3351 (38.3) | 1706 (31.0) | <0.0001 | | Elective surgery (vs. emergency) | 8433 (96.3) | 4312 (78.4) | <0.0001 |
Back to 2015 Annual Meeting Program
|
