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Laparoscopic colectomy for diverticulitis in patients with pre-operative respiratory comorbidity: analysis of post-operative outcomes in the United States from 2005 to 2017.
Patel, Richa; Zagadailov, Pavel; Merchant, Aziz M.
Affiliation
  • Patel R; Department of Surgery, Rutgers New Jersey Medical School, 185 South Orange Avenue, Suite MSB G530, Newark, NJ, 07103, USA.
  • Zagadailov P; Clinical Outcomes Research Group, CORG LLC, Grantham, NH, 03753, USA.
  • Merchant AM; Department of Surgery, Rutgers New Jersey Medical School, 185 South Orange Avenue, Suite MSB G530, Newark, NJ, 07103, USA. Aziz.merchant@rutgers.edu.
Surg Endosc ; 34(4): 1665-1677, 2020 04.
Article in En | MEDLINE | ID: mdl-31286256
BACKGROUND: Current studies suggest that laparoscopic colorectal surgery is an advantageous alternative to open surgery due to improved post-operative outcomes in high-risk patient groups. Limited data is currently available on the benefits of minimally invasive colectomy for diverticulitis in patients with significant pre-operative respiratory comorbidities. STUDY DESIGN: The NSQIP 2005-2017 datasets were used to identify patients that underwent partial colectomies due to diverticulitis. Partial colectomy cases were identified using CPT codes and then filtered to include only ICD 9 and 10 codes for diverticulitis. Pre-operative respiratory comorbidities included dyspnea, chronic obstructive pulmonary disease (COPD), and smoking status. Propensity matching was performed based on patient demographic and pre-operative risk factor data to create comparable groups for each respiratory comorbidity subset. Outcomes of interest were 30-day post-operative mortality and morbidity, incidence of return to operating room (ROR), and hospital length of stay (LoS). Laparoscopy and open surgery groups were compared using Chi square tests for categorical variables and t tests for continuous variables. A p value less than 0.05 was considered statistically significant. RESULTS: Among 70,420 cases with diverticulitis, 15,237 cases were identified as smokers, 3934 had dyspnea, and 3219 had COPD. Patients that had open procedures had significantly greater odds of mortality (OR 2.624 for smokers; OR 2.698 for dyspnea; OR 2.663 for COPD), morbidity (OR 2.590 for smokers; OR 2.344 for dyspnea; OR 2.883 for COPD), wound complication (OR 1.989 for smokers; OR 1.461 for dyspnea; OR 1.956 for COPD), and ROR (OR 1.184 for smokers; OR 1.634 for dyspnea; OR 1.975 for COPD). Laparoscopic procedures resulted in significantly lower average LoS (5.34 vs. 9.46 days for smokers; 6.84 vs. 11.06 days for dyspnea; 7.41 vs. 12.62 days for COPD; all p < .0001). CONCLUSION: Laparoscopic colectomy for diverticulitis diagnosis for a matched cohort of patients with pre-operative respiratory comorbidities such as smoking status, dyspnea, and COPD resulted in significantly improved post-operative outcomes, lower odds of mortality and morbidity, and shorter LoS.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Postoperative Complications / Respiration Disorders / Laparoscopy / Colectomy / Diverticulitis Type of study: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: America do norte Language: En Journal: Surg Endosc Journal subject: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Year: 2020 Document type: Article Affiliation country: United States Country of publication: Germany

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Postoperative Complications / Respiration Disorders / Laparoscopy / Colectomy / Diverticulitis Type of study: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: America do norte Language: En Journal: Surg Endosc Journal subject: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Year: 2020 Document type: Article Affiliation country: United States Country of publication: Germany