title: A laparoscopic approach reduces short-term complications and length of stay following ileocolic resection in Crohn's disease: an analysis of outcomes from the NSQIP database.
abstract: OBJECTIVE
  Studies to date examining the impact of laparoscopy in resection for Crohn's disease on short-term morbidity have been limited by small study populations. The aim of this study was to establish the impact of the operative approach (laparoscopic or open) on outcomes after ileocolic resection for Crohn's disease.
  
  
  METHODS
  Ileocolic resections for Crohn's disease were identified using Current Procedural Terminology (CPT) and International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes from the National Surgical Quality Improvement Program (NSQIP) database (2005-2009). Complications were categorized as major (organ system damage and systemic sepsis) or minor (incisional and urinary infections). Multivariate 30-day outcomes and length of stay were determined using linear models adjusting for patient characteristics, comorbidities and operative approach.
  
  
  RESULTS
  Of 1917 ileocolic resections, 644 (34%) were performed laparoscopically. At baseline, the open group was significantly older, had more comorbidities, higher American Society of Anesthesiology (ASA) classes, and more intra-operative transfusions (all variables, P<0.05). On multivariate analysis, laparoscopic ileocolic resections were associated with a decrease in major (OR=0.629, 95% CI: 0.430-0.905, P=0.014) and minor (OR=0.576, 95% CI: 0.405-0.804, P=0.002) complications compared with open resections. Laparoscopy was associated with a significant reduction in adjusted length of stay compared with the open approach (-1.08±0.29 days, P=0.0002).
  
  
  CONCLUSIONS
  After adjusting for comorbidities and perioperative factors, such as preoperative sepsis, higher ASA class and higher transfusion rates in the open group, laparoscopic ileocolic resection for Crohn's disease was found to be a safer choice than the open approach, resulting in fewer complications and length of stay. All other things being equal, such patients should be offered the laparoscopic approach as a first-choice option.
authors.affiliation: Division of Colorectal Surgery, Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York 14642, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Lee
authors.forename: F J
authors.initials: FJ
authors.lastname: Fleming
authors.forename: A-P
authors.initials: AP
authors.lastname: Deeb
authors.forename: D
authors.initials: D
authors.lastname: Gunzler
authors.forename: S
authors.initials: S
authors.lastname: Messing
authors.forename: J R T
authors.initials: JR
authors.lastname: Monson
mesh_terms: D000328:Adult; D001803:Blood Transfusion; D003082:Colectomy; D016001:Confidence Intervals; D003424:Crohn Disease / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D013997:Time Factors; D055815:Young Adult