Caitlyn Braschi1, Jessica K Liu1, Ashkan Moazzez2, Beverley A Petrie1. 1. Division of Colon & Rectal Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA. 2. Division of General & Bariatric Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA. amoazzez@dhs.lacounty.gov.
Abstract
PURPOSE: Laparoscopy is the preferred approach to elective surgery for diverticulitis and is increasingly common in the emergent setting. Although diverticulitis is most prevalent among older adults, little is known about the safety of laparoscopy for elderly patients with diverticulitis. This study aims to compare 30-day outcomes of a laparoscopic versus open approach for diverticulitis among elderly patients undergoing elective and urgent/emergent surgery. METHODS: Patients ≥ 65 years who underwent surgery for diverticulitis from 2015 to 2019 were identified from the ACS-NSQIP database. Elective and non-elective groups were analyzed separately. Coarsened exact matching matched laparoscopic and open patients 1:1 based on preoperative factors to minimize selection bias by creating comparable cohorts. Short-term outcomes of laparoscopic versus open surgery were compared. RESULTS: A total of 15,316 patients were included, 69.2% female and 88% White, with a mean age of 72.7 ± 6.1 years. Approximately half (50.9%) of cases were laparoscopic and 60.6% were elective. After matching, laparoscopy was associated with lower 30-day morbidity in both the elective (OR, 0.47; 95%CI, 0.38-0.58) and non-elective (OR, 0.76; 95%CI, 0.58-0.98) cohorts. Laparoscopic surgery in both cohorts was associated with fewer surgical site infections (SSIs) (elective, OR 0.43; 95%CI, 0.33-0.57; non-elective, OR, 0.66; 95%CI, 0.44-0.98) and shorter length of stay (LOS) (elective, mean difference, 1.7 days; 95%CI, 1.5-1.9; non-elective, mean difference, 1.2 days; 95%CI, 0.43-2.1). CONCLUSION: Elderly patients undergoing both elective and non-elective laparoscopic surgery for diverticulitis have less 30-day morbidity, SSIs, and shorter LOS compared to an open approach. Therefore, laparoscopy for elderly patients is safe in elective surgery and in select emergent cases as well.
PURPOSE: Laparoscopy is the preferred approach to elective surgery for diverticulitis and is increasingly common in the emergent setting. Although diverticulitis is most prevalent among older adults, little is known about the safety of laparoscopy for elderly patients with diverticulitis. This study aims to compare 30-day outcomes of a laparoscopic versus open approach for diverticulitis among elderly patients undergoing elective and urgent/emergent surgery. METHODS: Patients ≥ 65 years who underwent surgery for diverticulitis from 2015 to 2019 were identified from the ACS-NSQIP database. Elective and non-elective groups were analyzed separately. Coarsened exact matching matched laparoscopic and open patients 1:1 based on preoperative factors to minimize selection bias by creating comparable cohorts. Short-term outcomes of laparoscopic versus open surgery were compared. RESULTS: A total of 15,316 patients were included, 69.2% female and 88% White, with a mean age of 72.7 ± 6.1 years. Approximately half (50.9%) of cases were laparoscopic and 60.6% were elective. After matching, laparoscopy was associated with lower 30-day morbidity in both the elective (OR, 0.47; 95%CI, 0.38-0.58) and non-elective (OR, 0.76; 95%CI, 0.58-0.98) cohorts. Laparoscopic surgery in both cohorts was associated with fewer surgical site infections (SSIs) (elective, OR 0.43; 95%CI, 0.33-0.57; non-elective, OR, 0.66; 95%CI, 0.44-0.98) and shorter length of stay (LOS) (elective, mean difference, 1.7 days; 95%CI, 1.5-1.9; non-elective, mean difference, 1.2 days; 95%CI, 0.43-2.1). CONCLUSION: Elderly patients undergoing both elective and non-elective laparoscopic surgery for diverticulitis have less 30-day morbidity, SSIs, and shorter LOS compared to an open approach. Therefore, laparoscopy for elderly patients is safe in elective surgery and in select emergent cases as well.
Authors: Anne O Lidor; Eric Schneider; Jodi Segal; Qilu Yu; Richard Feinberg; Albert W Wu Journal: J Gastrointest Surg Date: 2010-09-28 Impact factor: 3.452
Authors: Hossein Masoomi; Brian Buchberg; Brian Nguyen; Vicrumdeep Tung; Michael J Stamos; Steven Mills Journal: World J Surg Date: 2011-09 Impact factor: 3.352
Authors: Amy J Sheer; Jennifer E Heckman; Eric B Schneider; Albert W Wu; Jodi B Segal; Richard Feinberg; Anne O Lidor Journal: Dis Colon Rectum Date: 2011-11 Impact factor: 4.585
Authors: Ryan S Turley; Andrew S Barbas; Michael E Lidsky; Christopher R Mantyh; John Migaly; John E Scarborough Journal: Dis Colon Rectum Date: 2013-01 Impact factor: 4.585
Authors: Sandra Vennix; Geesien S Boersema; Christianne J Buskens; Anand G Menon; Pieter J Tanis; Johan F Lange; Willem A Bemelman Journal: Dig Surg Date: 2015-11-10 Impact factor: 2.588