Effect of surgical approach on 30-day mortality and morbidity after elective colectomy: a NSQIP study.

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.