Laparoscopically assisted vs. open elective colonic and rectal resection: a comparison of outcomes in English National Health Service Trusts between 1996 and 2006.
OBJECTIVE
This study was designed to compare outcomes after elective laparoscopic and conventional colorectal surgery over a ten-year period using data from the English National Health Service Hospital Episode Statistics database.


METHODS
All elective colonic and rectal resections carried out in English Trusts between 1996 and 2006 were included. Univariate and multivariate analyses were used to compare 30 and 365-day mortality rates, 28-day readmission rates, and length of stay between laparoscopic and open surgery.


RESULTS
Between the study dates 3,709 of 192,620 (1.9%) elective colonic and rectal resections were classified as laparoscopically assisted procedures. The 30-day and 365-day mortality rates were lower after laparoscopic resection than after open surgery (P < 0.05). After correction for age, gender, diagnosis, operation type, comorbidity, and social deprivation, laparoscopic surgery was a strong determinant of reduced 30-day (odds ratio, 0.57; 95% confidence interval, 0.44-0.74; P < 0.001) and one-year (odds ratio, 0.53; 95% confidence interval, 0.42-0.67; P < 0.001) mortality. Similarly, multivariate analysis confirmed that laparoscopic surgery was independently associated with reduced hospital stay (P < 0.001). Patients who received rectal procedures for malignancy, however, were more likely to be readmitted if laparoscopy rather than by a traditional method was used (11.9% vs. 9.1%, P = 0.003).


CONCLUSIONS
In the present study, patients selected for laparoscopic colorectal surgery were associated with reduced postoperative mortality when compared with those undergoing the conventional technique. This finding merits further investigation.
Faiz
O
O
Department of Surgical Oncology and Technology, St. Mary's National Health Service Trust, London, United Kingdom. omarfaiz@aol.com
Warusavitarne
J
J
Bottle
A
A
Tekkis
P P
PP
Darzi
A W
AW
Kennedy
R H
RH
D000328:Adult; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods* / Q000401:mortality; D004739:England / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D016896:Treatment Outcome