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THE ADOPTION OF LAPAROSCOPIC COLON RESECTION FOR CROHN'S DISEASE: A STUDY FROM NSQIP DATABASE
H. Hande Aydinli*1, Erman Aytac2, Alexis Grucela1, Mitchell Bernstein1, Feza H. Remzi1
1Department of Surgery, Division of Colon and Rectal Surgery, New York University, New York, NY; 2Department of Surgery, Acibadem University School of Medicine , Istanbul, Turkey
Introduction: The suitability of minimally invasive surgery for Crohn’s disease has been debated. Data is limited on both the nationwide adoption of laparoscopic colon resection for Crohn’s Disease and outcomes when compared to open colectomy. This study aimed to compare patients undergoing open and laparoscopic colon resection for Crohn’s disease with respect to perioperative variables and 30-day postoperative outcomes.
Methods: Patients who underwent colon resection due to Crohn’s disease between 2005 and 2012 were identified using current procedural terminology codes from American College of Surgeons National Surgical Quality improvement program database. Patients were divided into two groups based on surgical approach (laparoscopic vs. open). Comparison of perioperative variables and 30-day postoperative outcomes between the groups were conducted.
Results: 4789 patients were identified with a mean age of 40±15 [2612 female (54%)]. Patient demographics, preoperative comorbidities and surgical details are summarized in table. 2007 operations (41%) were done laparoscopically. The incidence of the laparoscopic approach was 18% in 2005 and increased to 47% in 2012 (p=<0.0001). Patients who underwent open surgery were slightly older (42±15.3 vs. 38±14.5), more often male (48.6% vs 41.2%), hypertensive (17.3% vs. 13%), smokers (30.3% vs. 26.7%), dyspneic (4% vs. 2.5%), functionally dependent (2.1% vs. 0.7%), with a history of bleeding disorders (2.1% vs.1.2%), lower albumin levels (<3.4 mg/dl) (38.2% vs. 24%) and required urgent or emergency surgery (7.9% vs. 1.6%). An ASA class of 1 or 2 (78.1% vs. 66.7%) and wound class of I or II (72.2% vs. 59.6%) were more common among the patients who underwent laparoscopic surgery. Laparoscopic approach was found to be related with lower 30-day morbidity (15.7% vs 24.1%) and shorter length of stay (6.5±5.7 vs. 9.2±8.4 days).
Conclusion: The adoption of laparoscopic colectomy has increased over the years with better postoperative 30-day morbidity and shorter length of stay.
Comparison of demographics, preoperative comorbidities and surgical details between the groups.
| | Laparoscopic approach, n=2007 | Open approach, n=2782 | p-value | | Age, years Â¥ | 38± 14.5 | 42± 15.3 | <0.0001 | <40 year-old
40-65 year-old
>65 year-old | 1198 (47.7)
700 (36.2)
109 (31.2) | 1309 (52.3)
1233 (63.8)
240 (68.9) | | | Gender (Female) | 1180 (58.8) | 1432 (51.4) | <0.0001 | | Ethnicity (White) | 1660 (90.2) | 2301 (89.5) | 0.36 | | BMI, kg/m2 Â¥ | 25.1 ±6.1 | 25.1 ±6.2 | 0.37 | | Diabetes mellitus | 53 (2.6) | 98 (3.5) | 0.08 | | HTN | 262 (13) | 483 (17.3) | <0.0001 | | Smoking | 537 (26.7) | 845 (30.3) | 0.006 | | Dyspnea | 52 (2.5) | 112 (4) | 0.006 | | Functional status | 14 (0.7) | 60 (2.1) | <0.0001 | | Steroid use | 827 (41.2) | 1117 (40.15) | 0.46 | | Bleeding disorders | 25 (1.2) | 59 (2.1) | 0.02 | | Albumin, <3.4 mg/dl | 344 (24.0) | 808 (38.2) | <0.0001 | | WBC, >11 cells/mcL | 319 (16.9) | 616 (22.9) | <0.0001 | | Operation year | | | <0.0001 | 2005
2006
2007
2008
2009
2010
2011
2012 | 20 (18.3)
108 (36.2)
164 (34.5)
214 (38.7)
243 (38.3)
296 (43.2)
411 (46.9)
512 (47.4) | 89
190
311
338
390
389
498
577 | | | Emergency | 33 (1.6) | 220 (7.9) | <0.0001 | | Wound class | | | <0.0001 | I-Clean
II-Clean/Contaminated
III-Contaminated
IV-Dirty/infected | 16 (0.8)
1434 (71.4)
431 (21.4)
126 (6.28) | 12 (0.4)
1648 (59.2)
657 (23.6)
465 (16.7) | | | ASA Classification | | | <0.0001 | 1-No disturb
2-Mild disturb
3-Severe disturb
4-Life threat | 61 (3.0)
1508 (75.1)
435 (21.6)
2 (0.1) | 74 (2.6)
1783 (64.1)
888(31.9)
33 (1.1) | | | Operative time, min, Â¥ | 150.9± 59.4 | 150.8± 74.1 | 0.009 |
Values are expressed as absolute numbers (percentages) unless indicated otherwise; Â¥ values are expressed as mean ± Standard Deviation. BMI: body mass index, WBC: white blood cell, ASA: American Society of Anesthesiologists
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