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Observational Study
. 2021 Aug 19;108(8):934-940.
doi: 10.1093/bjs/znab048.

A national propensity score-matched analysis of emergency laparoscopic versus open abdominal surgery

P H Pucher  1 , H Mackenzie  2 , V Tucker  3 , S J Mercer  1
Affiliations
Observational Study

A national propensity score-matched analysis of emergency laparoscopic versus open abdominal surgery

P H Pucher et al. Br J Surg. .

Abstract

Background: Laparoscopy has been widely adopted in elective abdominal surgery but is still sparsely used in emergency settings. The study investigated the effect of laparoscopic emergency surgery using a population database.

Methods: Data for all patients from December 2013 to November 2018 were retrieved from the NELA national database of emergency laparotomy for England and Wales. Laparoscopically attempted cases were matched 2 : 1 with open cases for propensity score derived from a logistic regression model for surgical approach; included co-variates were age, gender, predicted mortality risk, and diagnostic, procedural and surgeon variables. Groups were compared for mortality. Secondary endpoints were blood loss and duration of hospital stay.

Results: Of 116 920 patients considered, 17 040 underwent laparoscopic surgery. The most common procedures were colectomy, adhesiolysis, washout and perforated ulcer repair. Of these, 11 753 were matched exactly to 23 506 patients who had open surgery. Laparoscopically attempted surgery was associated with lower mortality (6.0 versus 9.1 per cent, P < 0.001), blood loss (less than 100 ml, 64.4 versus 52.0 per cent, P < 0.001), and duration of hospital stay (median 8 (i.q.r. 5-14) versus 10 (7-18) days, P < 0.001). Similar trends were seen when comparing only successful laparoscopic cases with open surgery, and also when comparing cases converted to open surgery with open surgery.

Conclusion: In appropriately selected patients, laparoscopy is associated with superior outcomes compared with open emergency surgery.

Plain language summary

Minimally invasive (laparoscopic) surgery has been widely adopted in elective surgery but is sparsely used in emergencies. The study used national data to look at outcomes for patients having laparoscopic or open surgery, and used statistical methods to match patients in each group for critical variables such as type of operation, age and how unwell they were at time of surgery. Laparoscopy was found significantly to improve outcomes with reduced duration of stay in hospital, and lower rates of death after surgery. This suggests laparoscopy should be considered for much wider use than is currently employed.

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Figures

Fig. 1
Fig. 1
Calibration plot comparing observed versus P-POSSUM predicted mortality for patient deciles (1st and 10th outlier deciles excluded). Difference in mortality between groups P < 0.001 (Kruskal–Wallis test).
See this image and copyright information in PMC

References

    1. NELA Project Team. Fifth Patient Report of the National Emergency Laparotomy Audit. London: Royal College of Anaesthetists, 2019.
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