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Colorectal surgery in Parkinson’s disease—outcomes and predictors of mortality

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Although diseases of the lower gastrointestinal tract are common in patients with Parkinson’s disease, there is a paucity of data regarding postoperative outcomes after colorectal surgery.

Methods

The Nationwide Inpatient Sample database (2007–2011) was utilized to analyze outcomes in patients with Parkinson’s disease (PD) undergoing colorectal surgery. Main outcomes were risk-adjusted inpatient morbidity, mortality, hospital charge, and length of hospital stay.

Results

A total of 6490 patients were identified. Utilization of laparoscopic surgery in Parkinson’s patients has progressively increased in frequency over the latest 5 years analyzed. The most common diagnoses were colorectal malignancy (39 %) and intestinal obstruction (20 %). Right hemicolectomy (37 %) and sigmoidectomy (30 %) were the most common operations. Laparoscopy was used in 18 % of Parkinson’s patients and most commonly in the elective setting. 54.3 % of Parkinson’s patients had emergency surgery compared to 38.6 % in non-Parkinson’s. Overall morbidity and mortality were significantly lower after laparoscopic surgery compared to open (20 vs. 25 % and 2.1 vs. 6.6 %, respectively). Length of stay was significantly shorter (OR −1.86; p < 0.01) for laparoscopic operations, but there were no significant differences in risk-adjusted outcomes between laparoscopic and open groups.

Conclusion

PD patients have high rates of morbidity and mortality after colorectal surgery; this may be because more than half of all patients in this population undergo emergent surgery. The laparoscopic approach appears to have short-term benefits in this patient population.

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Acknowledgments

Disclosures

Dr. Pigazzi is a consultant for Intuitive Surgical, Cook, Ethicon, Covidien, and Cubist. He has received consultancy fees and educational grants paid to the Department of Surgery, University of California at Irvine. Dr. Stamos is a consultant for Ethicon, Olympus, Gore, NiTi/NovoGI, and Adolor/GlaxoSmithKline. Covidien training support has been paid to the University of California, Irvine, for clinical immersion courses for laparoscopic colectomy. Dr. Mills is a consultant for Ethicon Endosurgery. Dr. Carmichael have received educational grant from Ethicon paid to the Department of Surgery, University of California at Irvine. Dr. Hermanowicz, Dr. Hwang, Dr. Young, Dr. Hanna, Dr. Menon, and Mr. Phelan have no disclosures.

Conflict of interest

The authors d no conflict of interest related to the content of the manuscript.

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Authors and Affiliations

  1. Department of Surgery, Irvine School of Medicine, University of California, Irvine, Orange, CA, USA

    Grace S. Hwang, Monica T. Young, Mark H. Hanna, Gopal Menon, Joseph C. Carmichael, Steven Mills, Michael J. Stamos & Alessio Pigazzi

  2. Department of Statistics, Irvine School of Medicine, University of California, Irvine, CA, USA

    Michael Phelan

  3. Department of Neurology, University of California Irvine, Irvine, CA, USA

    Neal Hermanowicz

  4. Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Grace S. Hwang

  5. Department of Surgery, University of California, Irvine, 333 City Blvd. West Suite 850, Orange, CA, 92868, USA

    Alessio Pigazzi

Authors
  1. Grace S. Hwang
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  2. Monica T. Young
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  3. Mark H. Hanna
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  4. Gopal Menon
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  5. Michael Phelan
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  6. Joseph C. Carmichael
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  7. Steven Mills
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  8. Michael J. Stamos
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  9. Neal Hermanowicz
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  10. Alessio Pigazzi
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Corresponding author

Correspondence to Alessio Pigazzi.

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Hwang, G.S., Young, M.T., Hanna, M.H. et al. Colorectal surgery in Parkinson’s disease—outcomes and predictors of mortality. Int J Colorectal Dis 30, 1051–1058 (2015). https://doi.org/10.1007/s00384-015-2256-0

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  • DOI: https://doi.org/10.1007/s00384-015-2256-0

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