Laparoscopy improves failure to rescue compared to open surgery for emergent colectomy

Area of Science:

• Surgical outcomes research
• Minimally invasive surgery
• Emergency general surgery

Background:

• Emergent colectomy has high morbidity and mortality rates.
• Laparoscopic colectomy is favored in elective settings, but its impact on emergent procedures is less understood.
• Failure to rescue (FTR) is a critical metric for surgical quality.

Purpose of the Study:

• To compare failure to rescue (FTR) rates between laparoscopic and open colectomy in the emergent setting.
• To evaluate the impact of surgical approach on mortality, morbidity, and length of hospital stay.
• To assess the safety and efficacy of laparoscopic versus open emergent colectomy.

Main Methods:

• Retrospective cohort study using The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.
• Included adult patients undergoing emergent colectomy from 2005-2018.
• Propensity matching was used to control for demographic and comorbidity differences between laparoscopic and open surgery groups.

Main Results:

• After propensity matching, 11,484 patients were analyzed (3,829 laparoscopic).
• Open colectomy was associated with significantly higher odds of FTR (OR 1.71), mortality (OR 1.72), and overall morbidity (OR 1.73) compared to laparoscopic.
• Laparoscopic colectomy resulted in a shorter hospital stay (10.4 vs 12.3 days) and fewer postoperative complications, including reduced need for return to the OR, prolonged ventilation, and septic shock.

Conclusions:

• Laparoscopic emergent colectomy is associated with improved outcomes compared to open surgery.
• The laparoscopic approach demonstrates safety and efficacy, leading to lower rates of failure to rescue, mortality, and morbidity.
• Laparoscopy is a promising strategy to enhance patient outcomes in emergent colectomy.