title: A nationwide analysis of laparoscopy in high-risk colorectal surgery patients.
abstract: BACKGROUND
  Due to safety concerns, the use of laparoscopy in high-risk colorectal surgery patients has been limited. Small reports have demonstrated the benefit of laparoscopy in this population; however, large comparative studies are lacking.
  
  
  METHODS
  A retrospective review of the Nationwide Inpatient Sample 2009 was conducted. Patients undergoing elective colorectal resections for benign and malignant pathology were included in the high-risk group if they had at least two of the following criteria: age > 70, obesity, smoking, anemia, congestive heart failure, valvular disease, diabetes mellitus, chronic pulmonary, kidney and liver disease. Using multivariate logistic regression, the outcomes of laparoscopic surgery were compared to open and converted surgery.
  
  
  RESULTS
  Of 145,600 colorectal surgery cases, 32.79% were high-risk. High-risk patients had higher mortality, hospital charges, and longer hospital stay compared to low-risk patients. The use of laparoscopy was lower in the high-risk group with higher conversion rates. In high-risk patients, compared to open surgery, laparoscopy was associated with lower mortality (OR = 0.60), shorter hospital stay, lower charges, decreased respiratory failure (OR = 0.53), urinary tract infection (OR = 0.64), anastomotic leak (OR = 0.69) and wound complications (OR = 0.46). Conversion to open surgery was not associated with higher mortality.
  
  
  CONCLUSIONS
  Laparoscopy in high-risk colorectal patients is safe and may demonstrate advantages compared to open surgery.
authors.affiliation: Department of Colorectal Surgery, University of California, Irvine School of Medicine, 333 City Blvd. West Suite 850, Orange, CA 92868, USA.
authors.forename: Celeste Y
authors.initials: CY
authors.lastname: Kang
authors.forename: Wissam J
authors.initials: WJ
authors.lastname: Halabi
authors.forename: Obaid O
authors.initials: OO
authors.lastname: Chaudhry
authors.forename: Vinh
authors.initials: V
authors.lastname: Nguyen
authors.forename: Noor
authors.initials: N
authors.lastname: Ketana
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Carmichael
authors.forename: Alessio
authors.initials: A
authors.lastname: Pigazzi
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
authors.forename: Steven
authors.initials: S
authors.lastname: Mills
mesh_terms: D000368:Aged; D003108:Colonic Diseases / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States