title: Effect of surgical approach on 30-day mortality and morbidity after elective colectomy: a NSQIP study.
abstract: OBJECTIVE
  The aim of this study was to evaluate the laparoscopic approach and pre- and postoperative conditions as predictors of 30-day mortality and morbidity in elective colectomy.
  
  
  METHODS
  Elective colectomies were identified in the 2005-2008 American College of Surgeons National Surgical Quality Improvement Program database. Multivariate logistic regression was used to model 30-day mortality and morbidity following elective colectomy. Propensity scores were calculated to decrease selection bias.
  
  
  RESULTS
  During the period studied, 14,321 patients underwent open colectomy and 10,409 underwent laparoscopic colectomy. Factors that significantly influenced mortality included male gender [odds ratio (OR) 1.4, confidence interval (CI) 1.07-1.9]; age (OR 1.07, CI 1.05-1.08); comorbidities including dyspnea, ascites, congestive heart failure, dialysis, or disseminated cancer; and postoperative conditions including reintubation (OR 2.6, CI 1.6-4.0), renal failure (OR 3.8, CI 2.1-6.9), stroke (OR 6.44, CI 2.4-17.6), and septic shock (OR 13.1, CI 8.76-19.4). While laparoscopy was not independently associated with mortality, it was associated with decreased postoperative morbidity including reintubation (OR 0.74, CI 0.59-0.91), renal failure (OR 0.60, CI 0.4-0.91), septic shock (OR 0.74, CI 0.59-0.92), wound infection (OR 0.58, CI0.44-0.77), and pneumonia (OR 0.71, CI 0.59-0.86).
  
  
  CONCLUSIONS
  Based on this analysis, laparoscopy was associated with a decrease in 30-day postoperative morbidity for colectomy. However, after adjusting for preoperative comorbidities and postoperative morbidities, laparoscopy did not independently influence mortality after colectomy.
authors.affiliation: Department of Surgery, Oregon Health & Science University, Portland, OR 97239-3098, USA.
authors.forename: Molly M
authors.initials: MM
authors.lastname: Cone
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Herzig
authors.forename: Brian S
authors.initials: BS
authors.lastname: Diggs
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Rea
authors.forename: Karin M
authors.initials: KM
authors.lastname: Hardiman
authors.forename: Kim C
authors.initials: KC
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods* / Q000401:mortality; D003108:Colonic Diseases / Q000453:epidemiology / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology