A population-based comparison of open versus minimally invasive abdominoperineal resection

Abstract Background Although minimally invasive colorectal surgery increases widely, outcomes following its use in complex operations such as the abdominoperineal resection (APR) remain indeterminate. Methods A review of the Nationwide Inpatient Sample (2008 to 2011) of all patients undergoing elect...

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Bibliographic Details
Published in:The American journal of surgery 2015-05, Vol.209 (5), p.815-823
Main Authors: Schlussel, Andrew T., D.O, Lustik, Michael B., M.S, Johnson, Eric K., M.D, Maykel, Justin A., M.D, Champagne, Brad J., M.D, Goldberg, Joel E., M.D, Steele, Scott R., M.D
Format: Article
Language:English
Subjects:
Abdomen - surgery
Abdominoperineal resection
Adolescent
Adult
Age
Aged
Colorectal cancer
Colorectal Surgery - methods
Confidence intervals
Elective Surgical Procedures - methods
Family income
Federal regulation
Female
Hawaii - epidemiology
Hospitalization
Hospitals
Humans
Inflammatory bowel disease
Laparoscopy
Laparoscopy - statistics & numerical data
Laparotomy - statistics & numerical data
Male
Medicaid
Metastasis
Middle Aged
Morbidity - trends
Mortality
Perineum - surgery
Population database
Population Surveillance
Postoperative complications
Postoperative Complications - epidemiology
Proctectomy
Retrospective Studies
Studies
Surgery
Survival Rate - trends
Variables
Young Adult
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Summary:Abstract Background Although minimally invasive colorectal surgery increases widely, outcomes following its use in complex operations such as the abdominoperineal resection (APR) remain indeterminate. Methods A review of the Nationwide Inpatient Sample (2008 to 2011) of all patients undergoing elective laparoscopic or open APR was conducted. Risk-adjusted 30-day outcomes were assessed using regression modeling accounting for patient characteristics, comorbidities, and surgical procedure. Results We identified 3,191 admissions meeting inclusion criteria (1,019 laparoscopic; 2,172 open). The conversion rate was 5%. Mortality was low and similar between groups (.88% vs .83%, P = .91). In-hospital complication rates were lower in the laparoscopic group (19% vs 29%, odds ratio .59, 95% confidence interval .49 to .71, P < .01), but conversion was associated with a higher rate (29% vs 18%, P < .01). Finally, a laparoscopic APR was associated with a shorter length of stay (5.3 vs 7.0 days, P < .01). Conclusion Laparoscopic APR is associated with improved outcomes and may be the preferred approach by surgeons with appropriate skills and experience.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2014.12.021