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Arch Surg. 2012 Mar;147(3):219-27. doi: 10.1001/archsurg.2011.311. Epub 2011 Nov 21.

Reduced risk of medical morbidity and mortality in patients selected for laparoscopic colorectal resection in England: a population-based study.

Author information

1
Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, South Wharf Road, London W21NY, England.

Abstract

OBJECTIVES:

To quantify the occurrence of significant medical complications following elective colorectal resection and investigate potential differences in medical morbidity following open and minimal access colorectal surgery.

DESIGN:

Retrospective analysis of Hospital Episode Statistics, which is a prospectively maintained national database.

SETTING:

All patients undergoing colorectal resection in National Health Service trusts in England.

PATIENTS:

Adult patients undergoing elective or planned surgery between April 2001 and March 2008.

INTERVENTION:

Colorectal resection for benign and malignant diagnoses.

MAIN OUTCOME MEASURES:

Mortality and morbidity at 30 days and 1 year following elective colorectal resection.

RESULTS:

One hundred thirty-eight thousand seven hundred thirty-five elective colorectal resections were identified between the study dates. Thirty-day in-hospital mortality was 3.4% and 1.7% following conventional and laparoscopic surgery, respectively (P < .001). Overall, the 30-day postoperative medical morbidity rate was 14.6%. Use of the minimal access approach demonstrated a significant reduction in total morbidity risk at 30 days (odds ratio, 0.79; P < .001) and 365 days (odds ratio, 0.81; P < .001) following case-mix adjustment. Multiple regression analyses demonstrated that cardiorespiratory complications and venous thromboembolism occurred less frequently during the index admission and up to 1 year following minimal access surgery when compared with the conventional approach (P < .049).

CONCLUSIONS:

In this population-based study, patients selected for laparoscopic colorectal resection were associated with lower risk of mortality as well as reduced cardiorespiratory and venous thromboembolic risk than those undergoing open surgery.

PMID:
22106248
DOI:
10.1001/archsurg.2011.311
[Indexed for MEDLINE]

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