S. Groene1, C. Chandrasekera1, T. Prasad1, A. Lincourt1, B. T. Heniford1, V. Augenstein1 1Carolinas Medical Center,Division Of Gastrointestinal And Minimally Invasive Surgery,Charlotte, NC, USA
Introduction: Rectal resections are considered a challenging part of colorectal surgery due to anatomy and difficulties in obtaining critical views and angles during anastomoses. For this reason, it is felt that there is an increased risk of post-operative complications with rectal resections compared to only colon resections. The aim of this study was to compare outcomes of patients who underwent rectal resections versus colon resections.
Methods: Review of the Carolinas Medical Center (CMC) NSQIP data for colorectal resections performed from 2013 to 2015 was conducted. Procedures were categorized as rectal vs colon based on CPT codes. Demographics, pre-operative co-morbidities, minor and major complications were evaluated using standard statistical methods.
Results: There were 637 patients in the sample; 219 patients underwent rectal resections and 418 colon resections. Patients undergoing rectal resections were younger (58.9±12.2 vs 61.7±15; p=0.001) with no differences in BMI, gender or race. Those undergoing rectal resections had lower rates of diabetes (11.4% vs 19.4%; p=0.04), COPD (3.2% vs 7.9%; p=0.02), and fewer emergent cases (3.6% vs 15.8%; p<0.001). Pre-operatively, they had lower ventilator use (1.4% vs 5%; p=0.03), transfusions (1.8% vs 8.8%; p<0.001) and sepsis (2.3% vs 10.3%; p<0.001). Rectal resections were more often done laparoscopically (78.3% vs 59.6%; p<0.001). Post-operatively, those undergoing rectal resections had lower rates of pneumonia (PNA) (0.5 vs 2.9%; p=0.04), transfusions (12.3 vs 22%; p=0.003), sepsis (5% vs 10.5%; p=0.02), decreased 30 day mortality rate (1.4% vs 5.3%; p=0.02) and a shorter length of stay (8.7±8.3d vs 10.2±9.5d; p=0.02). After controlling for pre-op ventilator use and COPD, multivariate analysis (MV) indicated no significant difference in post-op PNA between the 2 groups. After controlling for pre-op transfusions and sepsis, MV analysis indicated no significant difference in post-op transfusions between the 2 groups. After controlling for pre-op sepsis, emergent case status and ASA class, MV analysis indicated no significant differences in post-op sepsis, 30 day mortality or LOS between the 2 groups. There were no significant differences in post-operative surgical site infections, deep infections, UTIs, cardiac or renal disease, DVTs/PEs, anastomotic leaks, unplanned returns to the OR, and death after 30 days between the 2 groups.
Conclusion: Patients undergoing rectal resections had fewer co-morbidities, underwent more laparoscopic and fewer emergent cases. They had fewer post-operative complications upon initial review of the data, though after controlling for ASA, pre-op sepsis and transfusions, emergent status and COPD, there were no significant differences between the groups. Rectal resections and colon resections appear to carry a similar risk of complications.