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Minimally invasive surgery and its impact on 30-day postoperative complications, unplanned readmissions and mortality
A Sood1,2, C P Meyer2, F Abdollah1
1Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA.
Background:
A critical appraisal of the benefits of minimally invasive surgery (MIS) is needed, but is lacking. This study examined the associations between MIS and 30-day postoperative outcomes including complications graded according to the Clavien-Dindo classification, unplanned readmissions, hospital stay and mortality for five common surgical procedures.
Methods:
Patients undergoing appendicectomy, colectomy, inguinal hernia repair, hysterectomy and prostatectomy were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Non-parsimonious propensity score methods were used to construct procedure-specific matched-pair cohorts that reduced baseline differences between patients who underwent MIS and those who did not. Bonferroni correction for multiple comparisons was applied and P < 0·006 was considered significant.
Results:
Of the 532 287 patients identified, 53·8 per cent underwent MIS. Propensity score matching yielded an overall sample of 327 736 patients (appendicectomy 46 688, colectomy 152 114, inguinal hernia repair 59 066, hysterectomy 59 066, prostatectomy 10 802). Within the procedure-specific matched pairs, MIS was associated with significantly lower odds of Clavien-Dindo grade I-II, III and IV complications (P ≤ 0·004), unplanned readmissions (P < 0·001) and reduced hospital stay (P < 0·001) in four of the five procedures studied, with the exception of inguinal hernia repair. The odds of death were lower in patients undergoing MIS colectomy (P < 0·001), hysterectomy (P = 0·002) and appendicectomy (P = 0·002).
Conclusion:
MIS was associated with significantly fewer 30-day postoperative complications, unplanned readmissions and deaths, as well as shorter hospital stay, in patients undergoing colectomy, prostatectomy, hysterectomy or appendicectomy. No benefits were noted for inguinal hernia repair.
Insights
Minimally invasive surgery (MIS) significantly reduces 30-day postoperative complications, readmissions, and mortality for appendicectomy, colectomy, hysterectomy, and prostatectomy. However, MIS showed no benefits for inguinal hernia repair outcomes.
Area of Science:
- Surgical Innovation
- Patient Outcomes Research
- Health Services Research
Background:
- A comprehensive evaluation of minimally invasive surgery (MIS) benefits is currently lacking.
- This study addresses the need for critical appraisal of MIS in common surgical procedures.
- Focus on 30-day postoperative outcomes including complications, readmissions, hospital stay, and mortality.
Purpose of the Study:
- To examine the associations between minimally invasive surgery (MIS) and 30-day postoperative outcomes.
- To compare outcomes across five common surgical procedures: appendicectomy, colectomy, inguinal hernia repair, hysterectomy, and prostatectomy.
- To assess the impact of MIS on complication rates, unplanned readmissions, hospital length of stay, and mortality.
Main Methods:
- Utilized the American College of Surgeons National Surgical Quality Improvement Program database.
- Identified patients undergoing appendicectomy, colectomy, inguinal hernia repair, hysterectomy, and prostatectomy.
- Employed non-parsimonious propensity score matching to create balanced cohorts for MIS and non-MIS groups, applying Bonferroni correction for statistical significance (P < 0.006).
Main Results:
- Of 532,287 identified patients, 53.8% underwent MIS. Propensity score matching resulted in 327,736 patients for analysis.
- MIS was linked to significantly lower odds of Clavien-Dindo grade I-II, III, and IV complications (P ≤ 0.004), unplanned readmissions (P < 0.001), and shorter hospital stays (P < 0.001) in four procedures, excluding inguinal hernia repair.
- Mortality rates were lower for MIS colectomy (P < 0.001), hysterectomy (P = 0.002), and appendicectomy (P = 0.002).
Conclusions:
- Minimally invasive surgery (MIS) is associated with significantly improved 30-day postoperative outcomes for colectomy, prostatectomy, hysterectomy, and appendicectomy.
- These benefits include reduced complications, fewer unplanned readmissions, and lower mortality rates.
- No significant postoperative benefits of MIS were observed for inguinal hernia repair compared to traditional surgery.
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