title: The impact of laparoscopic versus open approach on reoperation rate after segmental colectomy: a propensity analysis.
abstract: BACKGROUND
  Reoperation rate has not been well studied as a primary outcome when comparing laparoscopic with open approaches for colorectal resection. The goal of this study was to determine the impact of a laparoscopic approach on rate of reoperation after elective segmental colectomy.
  
  
  METHODS
  The NSQIP PUF for 2005-2011 was used to retrospectively identify patients who underwent open or laparoscopic elective segmental colectomy. The primary outcome measure was 30-day reoperation rate. A multivariable logistic regression model was constructed to determine the independent effect of surgical approach on rates of unplanned reoperation. This was validated with inverse propensity score weighting.
  
  
  RESULTS
  A total of 39,063 patients met the study inclusion criteria. A total of 1,702 reoperations were identified. After open approach, 5.1 % required reoperation, compared to 3.8 % in the laparoscopic group. After adjusting for confounders, open resection had 1.17-fold higher odds than laparoscopy for risk of reoperation, but this was not statistically significant (p = 0.07).
  
  
  CONCLUSIONS
  Using a large clinical dataset, we found that for segmental colectomy, there was not a statistically significant difference in odds of return to the operating room for laparoscopic versus open surgical approach. Reoperation is a relatively rare but costly complication and remains a potential area for quality improvement.
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA, paul.speicher@duke.edu.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.forename: Brian R
authors.initials: BR
authors.lastname: Englum
authors.forename: Betty
authors.initials: B
authors.lastname: Jiang
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Mantyh
authors.forename: John
authors.initials: J
authors.lastname: Migaly
mesh_terms: D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies
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