Background
Laparoscopic colectomy was considered initially to be contraindicated in patients
at high risk for operative morbidity and mortality. We hypothesized that this procedure
is safe to perform in high-risk patients, stratifying this risk using National VA
Surgical Quality Improvement Program (NSQIP) algorithms.
Methods
A case-matched, comparative study was performed for high-risk veteran patients who
underwent colectomy during the period October 2002–September 2004. Consecutive patients
undergoing laparoscopic colectomy were matched to patients who underwent open colectomy
during the same period for age, body mass index (BMI), procedure, and NSQIP-predicted
risk. The groups were compared for risk-stratified, 30-day morbidity/mortality, length
of stay (LOS), and operating time.
Results
Forty-five patients (23 laparoscopic and 22 open cases) were defined as at high risk
for complications (predicted complication >0.15). The rate of major complications
was significantly less in the laparoscopic group. There were 4 (18%) cases of postoperative
respiratory failure in the open group and none in the laparoscopic group. There was
no surgically related mortality in the laparoscopic group, compared with 2 deaths
in the open group (P = .5). Median LOS was less in the laparoscopic group (5 days) compared with open
(8 days) (P = .001). There were no significant differences in operating time or the number of
minor complications.
Conclusions
Our results suggest that the laparoscopic approach to colorectal diseases is safe
in the population of patients at high risk for operative morbidity and mortality.
Rather, this approach may represent a safer alternative to open access.
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Article info
Publication history
Accepted:
July 1,
2007
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- ErratumSurgeryVol. 143Issue 2
- PreviewAs a result of a production error, several articles appearing in the Central Surgical Association (Surgery, 2007; Vol. 142, No. 4:433-644) and American Association of Endocrine Surgeons (Surgery, 2007; Vol. 142, No. 6:785-1030) special focus issues were published without their respective discussions. The articles affected have now been updated online to include the missing discussion material. Surgery apologizes to the authors for this significant oversight.
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