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Laparoscopic vs Open Colectomy
Outcomes Comparison Based on Large Nationwide Databases
Ulrich Guller, MD, MHS;
Nitin Jain, MBBS, MSPH;
Sheleika Hervey, MD;
Harriett Purves, MPH;
Ricardo Pietrobon, MD
Arch Surg. 2003;138:1179-1186.
Hypothesis Laparoscopic colectomy has significant advantages over open colectomy in the treatment of diverticular disease with respect to the length of hospital stay, routine hospital discharge, and postoperative morbidity and mortality.
Design Retrospective secondary data analysis.
Patients and Setting Patients with primary International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes for laparoscopic (709 patients [3.8%]) and open sigmoid resection (17 735 patients [96.2%]) were selected from the 1998, 1999, and 2000 Nationwide Inpatient Samples. These databases represent 20% stratified probability samples of all US community hospital discharges. Sampling weights were used to allow generalization of the study findings to the overall US population. Multiple linear and logistic regression analyses were performed to assess the risk-adjusted association between the surgery type and patient outcomes.
Main Outcome Measures Length of hospital stay, in-hospital complications, in-hospital mortality, and the rate of routine discharge.
Results The patients had a mean age of 59.8 years; they were preponderantly white (89.1%) and female (54.0%). After adjusting for other covariates, laparoscopic sigmoidectomy was associated with a shorter mean hospital stay (laparoscopic sigmoidectomy vs open sigmoidectomy, 7.47 vs 9.37 days; P<.001), fewer gastrointestinal tract complications (odds ratio, 0.57; 95% confidence interval, 0.35-0.93; P = .03), a lower overall complication rate (odds ratio, 0.64; 95% confidence interval, 0.47-0.88; P = .007), and a higher routine hospital discharge rate (odds ratio, 2.21; 95% confidence interval, 1.51-3.21; P<.001).
Conclusion Laparoscopic sigmoid resection in patients with diverticular disease has statistically and clinically significant advantages over open sigmoid resection with respect to the length of hospital stay, rate of routine hospital discharge, and postoperative in-hospital morbidity.
From the Department of Surgery, Duke University Medical Center (Dr Guller), and Center for Excellence in Surgical Outcomes (Drs Guller, Jain, Hervey, and Pietrobon and Ms Purves) and the Division of Orthopedic Surgery (Drs Jain and Pietrobon), Duke University Medical Center, Durham, NC.
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