Laparoscopic vs open partial colectomy in elderly patients:Insights from the American College of Surgeons- National Surgical Quality Improvement Program database

• Published in: World journal of gastroenterology : WJG Vol. 21; no. 45; pp. 12843 - 12850
• Main Authors: Kannan, Umashankkar, Reddy, Vemuru Sunil K, Mukerji, Amar N, Parithivel, Vellore S, Shah, Ajay K, Gilchrist, Brian F, Farkas, Daniel T
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 07-12-2015
• Subjects: Age Factors; Aged; Aged, 80 and over; Chi-Square Distribution; Colectomy - adverse effects; Colectomy - methods; Colectomy - mortality; Colectomy;Laparoscopic;Outcomes;Elderly;National; Databases, Factual; Female; Humans; Laparoscopy - adverse effects; Laparoscopy - mortality; Length of Stay; Male; Odds Ratio; Postoperative Complications; Propensity Score; Retrospective Cohort Study; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; United States; Colectomy; National Surgical Quality Improvement Program; Laparoscopic; Elderly; Outcomes
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v21.i45.12843

AIM: To compare the outcomes between the laparoscopic and open approaches for partial colectomy in elderly patients aged 65 years and over using the American College of Surgeons- National Surgical Quality Improvement Program(ACS NSQIP) database. METHODS: The ACS NSQIP database for the years 2005-2011 was queried for all patients 65 years and above who underwent partial colectomy. 1:1 propensity score matching using the nearest- neighbor method was performed to ensure both groups had similar preoperative comorbidities. Outcomes including postoperative complications, length of stay and mortality were compared between the laparoscopic and open groups. χ2 and Fisher’s exact test were used for discrete variables and Student’s t-test for continuous variables. P < 0.05 was considered significant and odds ratios with 95%CI were reported when applicable. RESULTS: The total number of patients in the ACS NSQIP database of the years 2005-2011 was 1777035. We identified 27604 elderly patients who underwent partial colectomy with complete data sets. 12009(43%) of the cases were done laparoscopically and15595(57%) were done with open. After propensity score matching, there were 11008 patients each in the laparoscopic(LC) and open colectomy(OC) cohorts. The laparoscopic approach had lower post-operative complications(LC 15.2%, OC 23.8%, P < 0.001), shorter length of stay(LC 6.61 d, OC 9.62 d, P < 0.001) and lower mortality(LC 1.6%, OC 2.9%, P < 0.001). CONCLUSION: Even after propensity score matching, elderly patients in the ACS NSQIP database having a laparoscopic partial colectomy had better outcomes than those having open colectomies. In the absence of specific contraindications, elderly patients requiring a partial colectomy should be offered the laparoscopic approach.