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Increasing Adoption of Laparoscopy in Urgent and Emergent Colectomies for Pediatric Ulcerative Colitis
Alicia C Greene1, Marc M Mankarious1, Adam Finkelstein2
1Department of Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania.
Insights
Minimally invasive surgery (MIS) is increasingly used for urgent pediatric ulcerative colitis (UC) colectomies. Outcomes for both open and MIS approaches are comparable in this emergent setting.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Surgical quality improvement
Background:
- Minimally invasive surgery (MIS) is standard for elective pediatric ulcerative colitis (UC) resections.
- The application and outcomes of MIS in urgent/emergent pediatric UC colectomies are less understood.
Purpose of the Study:
- To evaluate trends in surgical approaches for pediatric UC patients undergoing urgent or emergent colectomies.
- To compare patient characteristics and clinical outcomes between open and MIS colectomy approaches in this population.
Main Methods:
- Retrospective review of 81 pediatric UC patients undergoing urgent/emergent colectomy (2012-2019) from the National Surgical Quality Improvement Program Pediatric database.
- Analysis of trends using linear regression and comparison of outcomes using univariate and multivariable statistics.
Main Results:
- The proportion of MIS colectomies increased by 5.53% annually.
- Open colectomies were associated with younger patients, more preoperative conditions (e.g., sepsis), and higher ASA classifications.
- While univariate analysis showed longer length of stay for open procedures, multivariable analysis revealed no significant difference in outcomes between open and MIS approaches after adjusting for confounders.
Conclusions:
- There is a consistent rise in the use of laparoscopic (MIS) colectomies for urgent/emergent pediatric UC.
- Short-term surgical outcomes appear comparable between open and MIS approaches in this setting.
Introduction:
While minimally invasive surgery (MIS) approaches are commonly utilized in the elective surgical setting for pediatric ulcerative colitis (UC), their role in urgent and emergent disease is less clear. We aim to assess trends in the surgical approaches for pediatric UC patients requiring urgent and emergent colectomies and their associated outcomes.
Methods:
Retrospective review of 81 pediatric UC patients identified in National Surgical Quality Improvement Program Pediatric who underwent urgent or emergent colectomy (2012-2019). Trends in approach were assessed using linear regression. Patient characteristics and clinical outcomes were stratified by approach and compared using standard univariate statistics. Multivariable analysis was used to model the influence of covariates on postoperative length of stay.
Results:
The proportion of MIS cases increased by 5.53% per year (P = 0.01) over the study interval. Sixty-three patients (77.8%) received MIS resections and 18 patients (22.2%) received open resections. Patients undergoing open colectomies were younger and had a higher proportion of preoperative conditions, most notably preoperative sepsis (27.8% versus 4.8%, P = 0.01), and higher American Society of Anesthesiologists [III-IV] classification (83.3% versus 58.8%, P = 0.004). Mean operative time was comparable (open, 173.6 versus MIS, 206.1 min). In the univariate analysis, open approach was associated with increased postoperative length of stay (13.1 versus 7.2 d, P = 0.002). However, after adjusting for confounders, there was no significant difference.
Conclusions:
There has been a steady increase in the adoption of laparoscopy in urgent and emergent colectomy for pediatric UC. Short-term outcomes between approaches appear comparable.
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