Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2015; 21(45): 12843-12850
Published online Dec 7, 2015. doi: 10.3748/wjg.v21.i45.12843
Laparoscopic vs open partial colectomy in elderly patients: Insights from the American College of Surgeons - National Surgical Quality Improvement Program database
Umashankkar Kannan, Vemuru Sunil K Reddy, Amar N Mukerji, Vellore S Parithivel, Ajay K Shah, Brian F Gilchrist, Daniel T Farkas
Umashankkar Kannan, Vemuru Sunil K Reddy, Amar N Mukerji, Vellore S Parithivel, Ajay K Shah, Brian F Gilchrist, Daniel T Farkas, Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, NY 10457, United States
Author contributions: Kannan U conceived of the idea; Kannan U, Reddy VSK, Mukerji AN, Parithivel VS, Shah AK, Gilchrist BF and Farkas DT designed the research; Kannan U collected the data; Kannan U and Farkas DT interpreted and analyzed the data; Kannan U and Farkas DT wrote the paper; Kannan U, Reddy VSK, Mukerji AN, Parithivel VS, Shah AK and Gilchrist BF edited the paper; Farkas DT supervised the project and performed the final revisions.
Institutional review board statement: This paper used public data with no protected health information (all the data is de-identified before going in the database) and is exempt from the Institutional Review Board.
Informed consent statement: No identifiable patients are involved in this study, and informed consent is not applicable.
Conflict-of-interest statement: None of the authors have any conflicts of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at dfarkas@bronxleb.org.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Daniel T Farkas, Department of Surgery, Bronx-Lebanon Hospital Center, 1650 Selwyn Avenue, Suite 4E, Bronx, NY 10457, United States. dfarkas@bronxleb.org
Telephone: +1-718-5901800
Received: June 20, 2015
Peer-review started: June 25, 2015
First decision: July 19, 2015
Revised: August 15, 2015
Accepted: October 13, 2015
Article in press: October 13, 2015
Published online: December 7, 2015
Processing time: 169 Days and 7.9 Hours
Abstract

AIM: To compare the outcomes between the laparoscopic and open approaches for partial colectomy in elderly patients aged 65 years and over using the American College of Surgeons - National Surgical Quality Improvement Program (ACS NSQIP) database.

METHODS: The ACS NSQIP database for the years 2005-2011 was queried for all patients 65 years and above who underwent partial colectomy. 1:1 propensity score matching using the nearest- neighbor method was performed to ensure both groups had similar pre-operative comorbidities. Outcomes including post-operative complications, length of stay and mortality were compared between the laparoscopic and open groups. χ2 and Fisher’s exact test were used for discrete variables and Student’s t-test for continuous variables. P < 0.05 was considered significant and odds ratios with 95%CI were reported when applicable.

RESULTS: The total number of patients in the ACS NSQIP database of the years 2005-2011 was 1777035. We identified 27604 elderly patients who underwent partial colectomy with complete data sets. 12009 (43%) of the cases were done laparoscopically and 15595 (57%) were done with open. After propensity score matching, there were 11008 patients each in the laparoscopic (LC) and open colectomy (OC) cohorts. The laparoscopic approach had lower post-operative complications (LC 15.2%, OC 23.8%, P < 0.001), shorter length of stay (LC 6.61 d, OC 9.62 d, P < 0.001) and lower mortality (LC 1.6%, OC 2.9%, P < 0.001).

CONCLUSION: Even after propensity score matching, elderly patients in the ACS NSQIP database having a laparoscopic partial colectomy had better outcomes than those having open colectomies. In the absence of specific contraindications, elderly patients requiring a partial colectomy should be offered the laparoscopic approach.

Keywords: Colectomy; Laparoscopic; Outcomes; Elderly; National Surgical Quality Improvement Program

Core tip: Elderly patients having partial colectomies are at greater risk for complications due to a higher incidence of comorbidities. This study looked at patients aged 65 and above in a nationally validated database from the American College of Surgeons National Surgical Quality Improvement Program. Patients having a laparoscopic partial colectomy, when compared to an open partial colectomy, had fewer complications, shorter lengths of stay and decreased mortality.