title: Laparoscopic peritoneal dialysis catheter placement is associated with decreased deep organ infection and reoperation.
abstract: BACKGROUND
  The optimal method for placement of peritoneal dialysis catheters (PDC) is unclear. The objective of this study was to compare the outcomes of laparoscopic and open surgical placement of PDC.
  
  
  METHODS
  Patients who underwent laparoscopic (LPD) and open (OPD) surgical placement of PDC between 2007 and 2011 were identified from the American College of Surgeons National Surgical Quality Initiative Project (NSQIP) dataset using current procedural terminology (CPT) and international classification of diseases 9th revision (ICD-9) codes. Perioperative outcomes were compared using Fisher's exact test for categorical variables, Student's t-test and Gamma regression were used for continuous variables. Catheter function was not reported in the dataset.
  
  
  RESULTS
  There were 1,560 PDC procedures in our study and most were performed laparoscopically (89%). 83% of these procedures were performed by general surgeons, mostly, with the patients under general anesthesia (95%). OPD was associated with a higher rate of perioperative deep organ infection (3.5% vs. 1.1%, p = 0.02) and need for reoperation (10.4% vs. 5.0%, p = 0.007). Operative time was, however, significantly longer with LPD (53.3 vs. 45.5 minutes, p < 0.001). In multivariate analysis, OPD was independently associated with increased risk of perioperative deep organ infection (odds ratio (OR) 3.7,95%, Confidence Interval (CI) 1.3 - 10.2, p = 0.01) and reoperation (OR 2.3, 95% CI 1.3 - 4.1, p = 0.005).
  
  
  CONCLUSIONS
  Laparoscopic PDC placement is more commonly performed and is associated with a lower risk of perioperative deep organ infection and reoperation than the open surgical approach. When possible, laparoscopic PDC placement might be preferable over open surgical placement.
authors: Louisiana State University Health Shreveport, Shreveport, LA, and Boston University Medical Center, Boston, MA, USA.
authors: Chyi Chyi
authors: CC
authors: Chong
authors: Tze-Woei
authors: TW
authors: Tan
authors: Kenneth
authors: K
authors: Abreo
authors: Marie E
authors: ME
authors: Pahilan
authors: Denis
authors: D
authors: Rybin
authors: Gheorghe
authors: G
authors: Doros
authors: Wayne W
authors: WW
authors: Zhang
authors: Alik
authors: A
authors: Farber
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000517:prevention & control; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies