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Reduced perioperative death following laparoscopic colorectal resection: results of an international observational study

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Abstract

Background

Laparoscopic approaches to colorectal surgery are known to accelerate recovery but the effect on postoperative mortality is uncertain. The purpose of this study was to determine whether differences exist in postoperative mortality between patients undergoing laparoscopic and open colorectal surgery in a group of international healthcare institutions.

Methods

Administrative data from 30 worldwide institutions were searched for patients who underwent elective colorectal surgical resection between January 2007 and December 2011. The primary outcome measure was 30-day-in-hospital mortality rate. Secondary outcome measures were 30-day readmission rate, length of stay, and 30-day reoperation rate.

Results

There were 30,369 (20,641 colonic and 9728 rectal) resections recorded over the 5 years. Eight thousand eighty-six were laparoscopic (26.6 %) and 22,283 (73.4 %) were open. Following propensity-score matching of the laparoscopic and open cohorts, mortality was 0.5 % following laparoscopic colectomy and 1.2 % after conventional surgery (P < 0.001). After adjusting for differences in preoperative risk factors including gender, age, comorbidity, type of surgery and diagnosis, by matching on propensity score, laparoscopic surgery was a strong determinant of reduced 30-day mortality (odds ratio 0.44; 95 % confidence interval 0.31–0.62; P < 0.001), reduced hospital stay (odds ratio 0.42, 95 % confidence interval 0.39–0.45; P < 0.001), reduced readmission (odds ratio 0.78, 95 % confidence interval 0.71–0.86; P < 0.001) and reduced re-operation (odds ratio 0.75, 95 % confidence interval 0.65–0.76; P < 0.001).

Conclusions

Minimally invasive colorectal surgery is associated with reduced in-hospital mortality when compared with conventional techniques. This finding is consistent across international healthcare institutions and supports efforts to disseminate laparoscopic skills.

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References

  1. Jacobs M, Verdeja J, Goldstein H (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1:144–150

    CAS  PubMed  Google Scholar 

  2. Phillips E, Franklin M, Carroll B, Fallas M, Ramos R, Rosenthal D (1992) Laparoscopic colectomy. Ann Surg 216:703–707

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Kemp JA, Finlayson SRG (2008) Nationwide trends in laparoscopic colectomy from 2000 to 2004. Surg Endosc 22:1181–1187

    Article  PubMed  Google Scholar 

  4. Thompson BS, Coory MD, Lumley JW (2011) National trends in the uptake of laparoscopic resection for colorectal cancer, 2000-2008. Med J Aust 194:443–447

    PubMed  Google Scholar 

  5. Schwenk W, Haase O, Neudecker JJ, Müller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev (2):CD003145. doi:10.1002/14651858.CD003145.pub2

  6. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229

    Article  PubMed  Google Scholar 

  7. COLOR Study Group (2000) COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Dig Surg 17:617–622

    Article  Google Scholar 

  8. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  9. Faiz O, Warusavitarne J, Bottle A, Tekkis PP, Darzi AW, Kennedy RH (2009) Laparoscopically assisted vs. open elective colonic and rectal resection: a comparison of outcomes in English National Health Service Trusts between 1996 and 2006. Dis Colon Rectum 52:1695–1704

    Article  CAS  PubMed  Google Scholar 

  10. Delaney CP, Chang E, Senagore AJ, Broder M (2008) Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg 247:819–824

    Article  PubMed  Google Scholar 

  11. Taylor EF, Thomas JD, Whitehouse LE, Quirke P, Jayne D, Finan PJ, Forman D, Wilkinson JR, Morris EJA (2013) Population-based study of laparoscopic colorectal cancer surgery 2006-2008. Br J Surg 100:553–560

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Kang CY, Chaudhry OO, Halabi WJ, Nguyen V, Carmichael JC, Stamos MJ, Mills S (2012) Outcomes of laparoscopic colorectal surgery: data from the Nationwide Inpatient Sample 2009. Am J Surg 204:952–957

    Article  PubMed  Google Scholar 

  13. Cone MM, Herzig DO, Diggs BS, Rea JD, Hardiman KM, Lu KC (2012) Effect of surgical approach on 30-day mortality and morbidity after elective colectomy: a NSQIP study. J Gastrointest Surg 16:1212–1217

    Article  PubMed  Google Scholar 

  14. Bottle A, Middleton S, Kalkman CJ, Livingston EH, Aylin P (2013) Global comparators project: international comparison of hospital outcomes using administrative data. Health Serv Res 48:2081–2100

    Article  PubMed Central  PubMed  Google Scholar 

  15. Bottle A, Aylin P (2011) Comorbidity scores for administrative data benefited from adaptation to local coding and diagnostic practices. J Clin Epidemiol 64:1426–1433

    Article  PubMed  Google Scholar 

  16. Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36:8–27

    Article  CAS  PubMed  Google Scholar 

  17. Rubin DB, Thomas N (1996) Matching using estimated propensity scores: relating theory to practice. Biometrics 52:249–264

    Article  CAS  PubMed  Google Scholar 

  18. Flury B, Riedwyl H (1986) Standard distance in univariate and multivariate analysis. Am Stat 40:249–251

    Google Scholar 

  19. Diggle P, Liang K, Zeger S (1994) The analysis of longitudanal data. Oxford University Press, New York

    Google Scholar 

  20. Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J (2006) Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 93:921–928

    Article  CAS  PubMed  Google Scholar 

  21. Abraham NS, Young JM, Solomon MJ (2004) Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 91:1111–1124

    Article  CAS  PubMed  Google Scholar 

  22. Tjandra JJ, Chan MKY (2006) Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Dis 8:375–388

    Article  CAS  PubMed  Google Scholar 

  23. Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P, Darzi AW, Heriot AG (2006) Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 13:413–424

    Article  PubMed  Google Scholar 

  24. Gao F, Cao Y-F, Chen L-S (2006) Meta-analysis of short-term outcomes after laparoscopic resection for rectal cancer. Int J Colorectal Dis 21:652–656

    Article  PubMed  Google Scholar 

  25. Clinical Outcomes of Surgery Therapy Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  Google Scholar 

  26. Laparoscopic colectomy for curable cancer. In: Am Soc Colon Rectal Surg (Position Statement). http://www.fascrs.org/physicians/position_statements/laparoscopic_colectomy/. Accessed 1 Sept 2013

  27. National Institute for Health and Care Excellence (2006) Laparoscopic surgery for colorectal cancer (T105). In: Natl Inst Heal Care Excell. http://publications.nice.org.uk/laparoscopic-surgery-for-colorectal-cancer-ta105. Accessed 1 Sept 2013

  28. Morris EJA, Taylor EF, Thomas JD, Quirke P, Finan PJ, Coleman MP, Rachet B, Forman D (2011) Thirty-day postoperative mortality after colorectal cancer surgery in England. Gut 60:806–813

    Article  PubMed  Google Scholar 

  29. Burns EM, Bottle A, Aylin P, Darzi A, Nicholls RJ, Faiz O (2011) Variation in reoperation after colorectal surgery in England as an indicator of surgical performance: retrospective analysis of Hospital Episode Statistics. BMJ 343:d4836

    Article  PubMed Central  PubMed  Google Scholar 

  30. Morris AM, Baldwin L-M, Matthews B, Dominitz JA, Barlow WE, Dobie SA, Billingsley KG (2007) Reoperation as a quality indicator in colorectal surgery: a population-based analysis. Ann Surg 245:73–79

    Article  PubMed Central  PubMed  Google Scholar 

  31. Li M, Xiao L, Wu W, Yang S, Li S (2012) Meta-analysis of laparoscopic versus open colorectal surgery within fast-track perioperative care. Dis Colon Rectum 55:821–827

    Article  PubMed  Google Scholar 

  32. Cummings LC, Delaney CP, Cooper GS (2012) Laparoscopic versus open colectomy for colon cancer in an older population: a cohort study. World J Surg Oncol 10:31

    Article  PubMed Central  PubMed  Google Scholar 

  33. Penninckx F, Kartheuser A, Van de Stadt J, Pattyn P, Mansvelt B, Bertrand C, Van Eycken E, Jegou D, Fieuws S (2013) Outcome following laparoscopic and open total mesorectal excision for rectal cancer. Br J Surg 100:1368–1375

    Article  CAS  PubMed  Google Scholar 

  34. Van Walraven C, Austin P (2012) Administrative database research has unique characteristics that can risk biased results. J Clin Epidemiol 65:126–131

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank The Gastrointestinal Goal Group of Dr Foster Global Comparators: David C. Chang, UC San Diego Medical Center, United States of America; Stephen Dalton, Royal United Hospital, Bath, United Kingdom; Alexander Engel, Royal North Shore Hospital, Sydney, Australia; Omar Faiz, St Marks Hospital and Academic Institute, United Kingdom; Edward Livingston, Southwestern Medical School and University of Texas at Arlington, United States of America; Najjia Mahmoud, University of Pennsylvania, United States of America; Jennifer L. Rabaglia, UT Southwestern Medical Center, United States of America; Sonia Ramamoorthy, Rebecca and John Moores Cancer Center, United States of America; Baljit Singh, University Hospitals Leicester, Leicester, United Kingdom; Rob Tollenaar, Leiden University Medical Center, The Netherlands; Mark I. van Berge Henegouwen, Academic Medical Center, Meibergdreef, Amsterdam, The Netherlands. Aruna Munasinghe is funded by a research fellowship grant from Cancer Research UK and the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Disclosures

Drs Munasinghe, Singh, Mahmoud, Joy, Chang, Penninckx and Faiz have no conflicts or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery and Cancer, Imperial College, St Mary’s Hospital, Praed Street, London, W2 1NY, UK

    A. Munasinghe & O. Faiz

  2. University Hospitals Leicester, Leicester, UK

    B. Singh

  3. Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, USA

    N. Mahmoud

  4. Dr Foster Ltd, 1st Floor Jarvis House, 12 Smithfield Street, London, EC1A 9LA, UK

    M. Joy

  5. School of Health Sciences, Surrey University, Surrey, UK

    M. Joy

  6. Department of Surgery, University of California, San Diego, USA

    D. C. Chang

  7. Department of Abdominal Surgery, University Hospitals Gasthuisberg, Leuven, Belgium

    F. Penninckx

  8. Surgical Epidemiology Trials and Outcomes Centre (SETOC), St Marks Hospital and Academic Institute, Northwick Park, Watford Road, Harrow, Middlesex, HA1 3UJ, UK

    O. Faiz

Authors
  1. A. Munasinghe
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  2. B. Singh
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  3. N. Mahmoud
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  4. M. Joy
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  5. D. C. Chang
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  6. F. Penninckx
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  7. O. Faiz
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Corresponding authors

Correspondence to A. Munasinghe or O. Faiz.

Additional information

On Behalf of The GI GOAL GROUP Dr Foster Global Comparators (GC) Project, Dr Foster Intelligence in association with the Dr Foster Unit at Imperial College London.

Appendix

Appendix

See Table 5.

Table 5 Changes in diagnosis codes associated with colectomy for diverticular disease and inflammatory bowel disease in the Global Comparators Dataset over the study period 2007–2011
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Munasinghe, A., Singh, B., Mahmoud, N. et al. Reduced perioperative death following laparoscopic colorectal resection: results of an international observational study. Surg Endosc 29, 3628–3639 (2015). https://doi.org/10.1007/s00464-015-4119-8

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  • DOI: https://doi.org/10.1007/s00464-015-4119-8

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