Effect of Surgical Approach on 30-Day Mortality and Morbidity After Elective Colectomy: A NSQIP Study

Abstract

Purpose: The aim of this study was to evaluate the laparoscopic approach and pre- and postoperative conditions as predictors of 30-day mortality and morbidity in elective colectomy. Methods: Elective colectomies were identified in the 2005-2008 American College of Surgeons National Surgical Quality Improvement Program database. Multivariate logistic regression was used to model 30-day mortality and morbidity following elective colectomy. Propensity scores were calculated to decrease selection bias. Results: During the period studied, 14,321 patients underwent open colectomy and 10,409 underwent laparoscopic colectomy. Factors that significantly influenced mortality included male gender [odds ratio (OR) 1. 4, confidence interval (CI) 1. 07-1. 9]; age (OR 1. 07, CI 1. 05-1. 08); comorbidities including dyspnea, ascites, congestive heart failure, dialysis, or disseminated cancer; and postoperative conditions including reintubation (OR 2. 6, CI 1. 6-4. 0), renal failure (OR 3. 8, CI 2. 1-6. 9), stroke (OR 6. 44, CI 2. 4-17. 6), and septic shock (OR 13. 1, CI 8. 76-19. 4). While laparoscopy was not independently associated with mortality, it was associated with decreased postoperative morbidity including reintubation (OR 0. 74, CI 0. 59-0. 91), renal failure (OR 0. 60, CI 0. 4-0. 91), septic shock (OR 0. 74, CI 0. 59-0. 92), wound infection (OR 0. 58, CI0. 44-0. 77), and pneumonia (OR 0. 71, CI 0. 59-0. 86). Conclusions: Based on this analysis, laparoscopy was associated with a decrease in 30-day postoperative morbidity for colectomy. However, after adjusting for preoperative comorbidities and postoperative morbidities, laparoscopy did not independently influence mortality after colectomy. © 2012 The Society for Surgery of the Alimentary Tract.