The effect of minimally invasive surgery on thirty-day postoperative outcomes of frail patients undergoing emergency colon resections

Abstract

Background: Frail patients have poor outcomes after emergent colon surgery. While minimally invasive surgery has shown improved outcomes in the general patient population undergoing colectomy, the benefits in frail patients are unknown.

Methods: We identified frail patients who underwent urgent or emergent colon resections from 2017 to 2021 in the National Surgical Quality Improvement Program database. We defined frail as a score of 2 or greater on the modified frailty index. We used inverse probability of treatment weighted analysis to determine the association of surgical technique with 30-day postoperative outcomes independent of confounding variables.

Results: Of the 11,976 frail patients, 10,293 (87.2%) underwent open surgery and 1,503 (12.7%) underwent minimally invasive surgery. Patients who underwent open surgery had significantly more comorbid conditions. The most common diagnosis for patients who underwent open surgery was intra-abdominal sepsis (59.6%) and neoplasms for patients who underwent minimally invasive surgery (42%). After the inverse probability of treatment weighted analysis, the standardized difference was reduced to 1.7% or less. At 30 days from surgery, minimally invasive surgery was independently associated with reduced risk of death: 4.6% (odds ratio, 0.95; 95% confidence interval, 0.93-0.97; P < .001), severe complications: 6.9% (odds ratio, 0.93; 95% confidence interval, 0.90-0.95, P < .001), any complication: 8.8% (odds ratio, 0.91; 95% confidence interval, 0.88-0.94, P < .001), septic shock: 5.9% (odds ratio, 0.94; 95% confidence interval, 0.92-0.96 P < .001), postoperative bleeding: 4% (odds ratio, 0.95; 95% confidence interval, 0.93-0.98, P < .001), hospital stay >14 days: 4.2% (odds ratio, 0.95; 95% confidence interval, 0.92-0.99, P = .02).

Conclusion: In this vulnerable population of frail patients, minimally invasive surgery was associated with reduced risk of morbidity and mortality in the 30 days after emergency colectomy. A minimally invasive surgery approach should be considered in emergency colon surgeries, provided proficient resources are available.