Reduced perioperative death following laparoscopic colorectal resection: results of an international observational study

Abstract

Background: Laparoscopic approaches to colorectal surgery are known to accelerate recovery but the effect on postoperative mortality is uncertain. The purpose of this study was to determine whether differences exist in postoperative mortality between patients undergoing laparoscopic and open colorectal surgery in a group of international healthcare institutions.

Methods: Administrative data from 30 worldwide institutions were searched for patients who underwent elective colorectal surgical resection between January 2007 and December 2011. The primary outcome measure was 30-day-in-hospital mortality rate. Secondary outcome measures were 30-day readmission rate, length of stay, and 30-day reoperation rate.

Results: There were 30,369 (20,641 colonic and 9728 rectal) resections recorded over the 5 years. Eight thousand eighty-six were laparoscopic (26.6%) and 22,283 (73.4%) were open. Following propensity-score matching of the laparoscopic and open cohorts, mortality was 0.5% following laparoscopic colectomy and 1.2% after conventional surgery (P < 0.001). After adjusting for differences in preoperative risk factors including gender, age, comorbidity, type of surgery and diagnosis, by matching on propensity score, laparoscopic surgery was a strong determinant of reduced 30-day mortality (odds ratio 0.44; 95% confidence interval 0.31-0.62; P < 0.001), reduced hospital stay (odds ratio 0.42, 95% confidence interval 0.39-0.45; P < 0.001), reduced readmission (odds ratio 0.78, 95% confidence interval 0.71-0.86; P < 0.001) and reduced re-operation (odds ratio 0.75, 95% confidence interval 0.65-0.76; P < 0.001).

Conclusions: Minimally invasive colorectal surgery is associated with reduced in-hospital mortality when compared with conventional techniques. This finding is consistent across international healthcare institutions and supports efforts to disseminate laparoscopic skills.

Keywords: Colorectal; Laparoscopy; Minimally invasive surgery.