D. T. Asuzu1, K. Y. Pei1 1Yale University School Of Medicine,Surgery,New Haven, CT, USA
Introduction:
Ascites increases perioperative complications and risk of death, but is not an absolute contra-indication for subtotal colectomy. It remains unclear whether this risk can be minimized using a laparoscopic versus open approach. We hypothesize that laparoscopic surgery reduces risk of complications and death in patients with ascites.
Methods:
Data was retrospectively analyzed from 2,419 patients with ascites who underwent laparoscopic or open colectomy from 2005 to 2013 using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Post-operative outcomes were compared using two-sample tests of proportions, or using two-sample T-tests after checking for variance equality with Welch’s approximation for degrees of freedom. Odds ratios (OR) and incidence rate ratios (IRR) for complications and death were calculated using univariable logistic regression or linear regression respectively. P values < 0.05 two-tailed were considered statistically significant.
Results:
218 patients (9%) with ascites underwent laparoscopic colectomy. Laparoscopic surgery was associated with lower 30-day mortality (15.6% versus 24.3%, OR 0.58, 95% CI 0.39 – 0.84, P = 0.004) and shorter hospital length of stay (9 days versus 15 days, IRR 0.0046, 95% CI 6E-4 – 0.034, P < 0.001). There was no significant difference in operative time (145 minutes versus 146 minutes, P = 0.69) or superficial surgical site infections (7.3% versus 7.7%) between laparoscopic versus open surgery.
Conclusion:
Laparoscopic colectomy reduces 30-day mortality and hospital length of stay in patients with ascites. This surgical modality may help mitigate the additional risk associated with ascites in patients undergoing subtotal colectomy.