title: Technique of last resort: characteristics of patients undergoing open surgery in the laparoscopic era.
abstract: BACKGROUND
  The utilization rates for minimally invasive colorectal resection techniques (MICR) continue to increase. In some centers MICR methods are the preferred approach, however, open methods continue to be utilized for select patients. In this study, the profile and short-term outcomes of open colorectal resection (CR) and MICR patients are determined and compared.
  
  
  METHODS
  A retrospective review of patients who underwent elective CR over 11 years at two institutions was performed. The MICR group contained both laparoscopic-assisted and hand-assisted cases. The past medical and surgical histories, indications, operations performed, and short-term outcomes were assessed. The Charlson co-morbidity index (CMI) was used to assess risk.
  
  
  RESULTS
  During the study period 1080 patients underwent CR (Open, 141; MICR, 939). As judged by the CMI, there were more high-risk patients (score ≥2) in the Open group (34.38%) versus MICR (22.11%) p = 0.0029. Significantly more open patients had prior abdominal surgery and specifically CRs (Open, 15.60% vs. MICR, 2.13%, p < 0.001). Intraoperative transfusion (Open 25.7%; MICR 6.8%, p < 0.001) and diversion (25.53 vs. 11.50%, p < 0.001) were more common in the Open group. Not surprisingly, recovery of bowel function and length of stay were longer for the Open group. The overall complication rate was also higher for the Open patients (p < 0.001).
  
  
  CONCLUSIONS
  When MICR is the procedure of choice, patients selected for Open CR are higher risk and more complex as judged by the CMI and past operative history. Not surprisingly, this translates into a longer length of stay, higher rates of transfusion, diversion, and complications. This disparity in patients undergoing CRs makes direct comparison of MICR and Open resection outcomes not reasonable.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Mt Sinai St Luke's/Mt Sinai Roosevelt Hospital Center, 1000 10th Ave, Suite 2B, New York, NY, 10019, USA, hamza.guend@gmail.com.
authors.forename: Hamza
authors.initials: H
authors.lastname: Guend
authors.forename: David Y
authors.initials: DY
authors.lastname: Lee
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Myers
authors.forename: Nipa D
authors.initials: ND
authors.lastname: Gandhi
authors.forename: Vesna
authors.initials: V
authors.lastname: Cekic
authors.forename: Richard L
authors.initials: RL
authors.lastname: Whelan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications; D020127:Recovery of Function; D012189:Retrospective Studies