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Use of minimally invasive surgery in emergency general surgery procedures

  • 2019 SAGES Oral
  • Published:
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Abstract

Background

Minimally invasive surgery (MIS) has demonstrated superior outcomes in many elective procedures. However, its use in emergency general surgery (EGS) procedures is not well characterized. The purpose of this study was to examine the trends in utilization and outcomes of MIS techniques in EGS over the past decade.

Methods

The 2007–2016 ACS-NSQIP database was utilized to identify patients undergoing emergency surgery for four common EGS diagnoses: appendicitis, cholecystitis/cholangitis, peptic ulcer disease, and small bowel obstruction. Trends over time were described. Preoperative risk factors, operative characteristics, outcomes, morbidity, and trends were compared between MIS and open approaches using univariate and multivariate analysis.

Results

During the 10-year study period, 190,264 patients were identified. The appendicitis group was the largest (166,559 patients) followed by gallbladder disease (9994), bowel obstruction (6256), and peptic ulcer disease (366). Utilization of MIS increased over time in all groups (p < 0.001). There was a concurrent decrease in mean days of hospitalization in each group: appendectomy (2.4 to 2.0), cholecystectomy (5.7 to 3.2), peptic ulcer disease (20.3 to 11.7), and bowel obstruction (12.9 to 10.5); p < 0.001 for all. On multivariate analysis, use of MIS techniques was associated with decreased odds of 30-day mortality, surgical site infection, and length of hospital stay in all groups (p < 0.001).

Conclusions

Use of MIS techniques in these four EGS diagnoses has increased in frequency over the past 10 years. When adjusted for preoperative risk factors, use of MIS was associated with decreased odds of wound infection, death, and length of stay. Further studies are needed to determine if increased access to MIS techniques among EGS patients may improve outcomes.

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Funding

This research did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite #300, 28203, Charlotte, NC, USA

    Michael Arnold, Sharbel Elhage, Lynnette Schiffern, B. Lauren Paton, Samuel W. Ross, Brent D. Matthews & Caroline E. Reinke

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Contributions

All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication before its appearance in The American Surgeon. Conception and design of study: MRA, SAE, LS, BLP, CER. Acquisition of data: MRA, SWR, CER. Analysis and/or interpretation of data: SWR, CER, BDM. Drafting the manuscript: MRA, SAE, SWR, CER. Revising the manuscript critically for important intellectual content: MRA, SAE, CER, LS, BLP, SWR, BDM

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Correspondence to Michael Arnold.

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Doctors Michael Arnold, Sharbel Elhage, Lynnette Schiffern, B. Lauren Paton, Samuel W. Ross, Brent D. Matthews, and Caroline E. Reinke have no conflicts of interest or financial ties to disclose, no pharmaceutical relationships, collect no honoraria, and have no personal relationships that could inappropriately influence this work or its conclusions.

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Arnold, M., Elhage, S., Schiffern, L. et al. Use of minimally invasive surgery in emergency general surgery procedures. Surg Endosc 34, 2258–2265 (2020). https://doi.org/10.1007/s00464-019-07016-1

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