title: Minimally invasive technique leads to decreased morbidity and mortality in small bowel resections compared to an open technique: an ACS-NSQIP identified target for improvement.
abstract: BACKGROUND
  We hypothesize that currently minimally invasive techniques are underutilized, leading to unnecessary morbidity and mortality. The objective of the study was to compare morbidity and mortality rates in patients receiving a minimally invasive (MIS) small bowel resection to patients receiving an open (OP) small bowel resection.
  
  
  METHODS
  Patients in the National Surgical Quality Improvement Program (NSQIP) database who underwent a small bowel resection between 2007 and 2011 were enrolled in the study and grouped whether they received a MIS procedure (n = 1,780) or an OP procedure (n = 17,701). The primary endpoint of the study was to evaluate the difference in morbidity (excluding mortality) and mortality in patients undergoing a minimally invasive procedure compared to an open procedure.
  
  
  RESULTS
  The MIS technique is utilized in 9.0 % of patients undergoing a small bowel resection. Significantly lower mortality rate (2.9 vs. 8.2 %; p < 0.001) and mean morbidity rate (1.7 vs. 4.3 %; p < 0.001) were demonstrated in the MIS group. Significantly lower mean major morbidity rate (1.4 vs. 3.9 %; p < 0.001) and mean minor morbidity rate (2.6 vs. 5.5 %; p < 0.001) were demonstrated in the MIS group.
  
  
  CONCLUSIONS
  The MIS technique in small bowel resections appears to be underutilized, with only 9.0 % of patients in need of a small bowel resection undergo the minimally invasive approach. Wider utilization of the MIS technique could lead to significantly decreased morbidity and mortality.
authors.affiliation: Department of General Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL, 60612, USA.
authors.forename: Shaun C
authors.initials: SC
authors.lastname: Daly
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Popoff
authors.forename: Louis
authors.initials: L
authors.lastname: Fogg
authors.forename: Amanda B
authors.initials: AB
authors.lastname: Francescatti
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Myers
authors.forename: Keith W
authors.initials: KW
authors.lastname: Millikan
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Deziel
authors.forename: Minh B
authors.initials: MB
authors.lastname: Luu
mesh_terms: D001803:Blood Transfusion; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D058996:Quality Improvement; D018805:Sepsis / Q000453:epidemiology*; D013530:Surgical Wound Infection / Q000453:epidemiology; D014481:United States / Q000453:epidemiology