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Laparoscopy impacts outcomes favorably following colectomy for ulcerative colitis: a critical analysis of the ACS-NSQIP database

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Abstract

Introduction

The surgical management of ulcerative colitis (UC) often involves complex operations. We investigated the outcome of patients who underwent surgery for UC by analyzing a nationwide database.

Methods

We queried the American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP, 2005–2008) for all UC patients who underwent colectomy. To analyze by operation, groupings included: partial colectomy (PC; n = 265), total abdominal colectomy (TAC; n = 232), total proctocolectomy with ileostomy (TPC-I; n = 134), and total proctocolectomy with ileal pouch-anal anastomosis (IPAA; n = 446) to analyze 30-day outcomes.

Results

From 1,077 patients (mean age, 44 years; 45 % female; 7 % emergent), a laparoscopic approach was used in 29.2 %, with rates increasing 8.5 % each year (18.5 % in 2005 to 41.3 % in 2008, P < 0.001). Complications occurred in 29 %, and laparoscopy was associated with a lower complication rate (21 vs. 32 % open, P < 0.001). On multivariate regression, postoperative complications increased when patients were not functionally independent [odds ratio (OR) = 3.2], had preoperative sepsis (OR = 2.0), or prior percutaneous coronary intervention (OR = 2.8). A laparoscopic approach was associated with a lower complication rate (OR = 0.63). When stratified by specific complications, laparoscopy was associated with lower complications, including superficial surgical site infections (11.4 vs. 6.7 %, P = 0.0011), pneumonia (2.9 vs. 0.6 %, P = 0.023), prolonged mechanical ventilation (3.9 vs. 1.3 %, P = 0.023), need for transfusions postoperatively (1.6 vs. 0 %, P = 0.016), and severe sepsis (2.9 vs. 1.0 %, P = 0.039). Laparoscopy was also was associated with a lower complication rate in TACs (41.7 vs. 18.8 %, P < 0.0001) and IPAA (29.9 vs. 18.2 %, P = 0.005) and had an overall lower mortality rate (0.2 vs. 1.7 %, P = 0.046).

Conclusions

Results from a large nationwide database demonstrate that a laparoscopic approach was utilized in an increasing number of UC patients undergoing colectomy and was associated with lower morbidity and mortality, even in more complex procedures, such as TAC and IPAA.

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Ethical standards

This paper has been approved by the Madigan Army Medical Center Human Use Institutional Review Board.

Disclosures

Authors Marlin W. Causey, Doug stoddard, Eric K. Johnson, Justin A. Maykel, Mathew J. Martin, David Rivadeneira and Scott R. Steele have no conflict of interest or financial ties to disclose.

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Author notes

  1. Scott R. Steele

    Present address: , 9606 Piperhill Dr. SE, Olympia, WA, 98513, USA

Authors and Affiliations

  1. Department of Surgery, Madigan Army Medical Center, Ft. Lewis, WA, USA

    Marlin W. Causey, Doug Stoddard, Eric K. Johnson, Matthew J. Martin & Scott R. Steele

  2. Department of Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA

    Justin A. Maykel

  3. Department of Surgery, St. Catherine of Siena Medical Center, Smithtown, NY, USA

    David Rivadeneira

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  1. Marlin W. Causey
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Correspondence to Marlin W. Causey.

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Causey, M.W., Stoddard, D., Johnson, E.K. et al. Laparoscopy impacts outcomes favorably following colectomy for ulcerative colitis: a critical analysis of the ACS-NSQIP database. Surg Endosc 27, 603–609 (2013). https://doi.org/10.1007/s00464-012-2498-7

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  • DOI: https://doi.org/10.1007/s00464-012-2498-7

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