Effect of Surgical Approach on 30-Day Mortality and Morbidity After Elective Colectomy

A NSQIP Study

Molly M. Cone, Daniel Herzig, Brian S. Diggs, Jennifer D. Rea, Karin M. Hardiman, Kim Lu

Research output: Contribution to journalArticle

20 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1212-1217
Number of pages6
JournalJournal of Gastrointestinal Surgery
Volume16
Issue number6
DOIs
StatePublished - Jun 2012

Fingerprint

Colectomy
Odds Ratio
Morbidity
Confidence Intervals
Mortality
Laparoscopy
Septic Shock
Renal Insufficiency
Comorbidity
Propensity Score
Selection Bias
Wound Infection
Quality Improvement
Ascites
Dyspnea
Dialysis
Pneumonia
Heart Failure
Logistic Models
Stroke

Keywords

  • Colectomy
  • Laparoscopy
  • NSQIP

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Effect of Surgical Approach on 30-Day Mortality and Morbidity After Elective Colectomy : A NSQIP Study. / Cone, Molly M.; Herzig, Daniel; Diggs, Brian S.; Rea, Jennifer D.; Hardiman, Karin M.; Lu, Kim.

In: Journal of Gastrointestinal Surgery, Vol. 16, No. 6, 06.2012, p. 1212-1217.

Research output: Contribution to journalArticle

Cone, Molly M. ; Herzig, Daniel ; Diggs, Brian S. ; Rea, Jennifer D. ; Hardiman, Karin M. ; Lu, Kim. / Effect of Surgical Approach on 30-Day Mortality and Morbidity After Elective Colectomy : A NSQIP Study. In: Journal of Gastrointestinal Surgery. 2012 ; Vol. 16, No. 6. pp. 1212-1217.
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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.",
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AB - 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.

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