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Laparoscopic Resection for Inflammatory Bowel Disease: Outcomes from a Nationwide Sample

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background and Aims

A significant proportion of patients with inflammatory bowel diseases (IBD) require surgery. While the majority of these are open procedures (OP), there is recent interest in laparoscopic resection (LS). There are no nationwide comparison of outcomes between LS and OP.

Methods

We used data from the Nationwide Inpatient Sample 2004 and identified patients with IBD who underwent ileocolonic/colonic resection using appropriate ICD-9 codes. Procedures were considered to be laparoscopic if they had concomitant codes for laparoscopy (International Classification of Diseases, Ninth edition, clinical modification 54.21/54.51). Multivariate regression was performed to identify independent predictors and outcomes.

Results

There were 209,206 IBD hospitalizations included in the study among whom, 884 underwent laparoscopic resections (5.3%). On multivariate analysis, fistulizing disease (odds ratio (OR) 0.35, 95% confidence interval (CI) 0.21–0.59) and emergent admission (OR 0.59, 95% CI 0.39–0.90) were negative while annual hospital IBD surgical volume of >50 procedures (OR 2.0, 95% CI 1.14–3.52) were positively associated with LS. LS was associated with a significantly lower proportion of postoperative complications (27.1% vs 35.4%, p < 0.001) and shorter postoperative length of stay compared to OP (−1.9 days, 95% CI −3.2 to −0.6 days). Propensity score adjustment for nonrandom allocation of patients into the treatment groups neutralized the OR for postoperative complication (OR 0.82) but not length of stay (−1.7 days).

Conclusion

LS had no increase in rate of complications and was associated with a shorter postoperative length of stay.

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Acknowledgment

This work was presented in part during Digestive Disease Week 2009, Chicago, IL.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA

    Ashwin N. Ananthakrishnan & Kia Saeian

  2. Division of Epidemiology, Medical College of Wisconsin, Milwaukee, WI, USA

    Emily L. McGinley

  3. Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    David G. Binion

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  1. Ashwin N. Ananthakrishnan
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  2. Emily L. McGinley
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  3. Kia Saeian
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Correspondence to Ashwin N. Ananthakrishnan.

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Ananthakrishnan, A.N., McGinley, E.L., Saeian, K. et al. Laparoscopic Resection for Inflammatory Bowel Disease: Outcomes from a Nationwide Sample. J Gastrointest Surg 14, 58–65 (2010). https://doi.org/10.1007/s11605-009-1040-2

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  • DOI: https://doi.org/10.1007/s11605-009-1040-2

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