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Advantages of Laparoscopic Colectomy in Older Patients
Anthony J. Senagore, MD, MS, MBA;
Khaled M. Madbouly, MD;
Victor W. Fazio, MD;
Hans J. Duepree, MD;
Karen M. Brady, BSN, RN, C;
Conor P. Delaney, MCh, PhD, FRCSI(Gen)
Arch Surg. 2003;138:252-256.
Hypothesis Few data describe the relative benefits of an expedited recovery program and laparoscopic technique in older vs younger patients undergoing colectomy. We compared short-term outcomes in age-matched cohorts of patients undergoing laparoscopic vs open segmental colectomy managed with the Controlled Rehabilitation With Early Ambulation and Diet program.
Design Four age-matched cohorts of patients were compared: (1) patients 70 years or older undergoing laparoscopic colectomy (group 1), (2) those 70 or older undergoing open colectomy (group 2), (3) those younger than 60 undergoing laparoscopic colectomy (group 3), and (4) those younger than 60 undergoing open colectomy (group 4).
Methods Data collected included age, sex, body mass index, Physiologic and Operative Severity Score for the Enumeration of Morbidity and Mortality, American Society of Anesthesiologists' score, estimated blood loss, operative duration in minutes, pathologic findings, type of segmental colectomy, complications, mortality, length of hospital stay, and 30-day readmission rate.
Results Four hundred seventy-six patients fulfilled the inclusion criteria and had complete data available for collection (group 1, 50 patients; group 2, 123 patients; group 3, 181 patients; and group 4, 122 patients). Demographic data, operative procedures, and pathologic findings were similar among the cohorts. The mean ± SEM length of hospital stay was significantly shorter with laparoscopic surgery in both age cohorts (group 1, 4.2 ± 3.0 days; group 2, 9.3 ± 7.6 days; group 3, 3.9 ± 5.9 days; and group 4, 6.1 ± 3.0 days). The mean ± SEM direct hospital costs were significantly lower only with laparoscopic colectomy in the older cohorts. Using the Physiologic and Operative Severity Score for the Enumeration of Morbidity and Mortality, it was noted that group 2 experienced an observed rate of morbidity similar to that predicted. Conversely, groups 1, 3, and 4 had rates that were significantly lower than expected. Mean ± SEM readmission rates were comparable in the older cohorts (group 1, 6.0%, and group 2, 6.5%) but significantly different in the younger cohorts (group 3, 9.4%, and group 4, 4.1%).
Conclusions The Controlled Rehabilitation With Early Ambulation and Diet program in combination with laparoscopic segmental colectomy can be safely performed in all age groups. The technique offers particular advantages to older patients because of reductions in length of hospital stay, morbidity and mortality rates, and direct cost of care.
From the Department of Colorectal Surgery, Minimally Invasive Surgery Center, The Cleveland Clinic Foundation, Cleveland, Ohio.
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