title: A population-based comparison of open versus minimally invasive abdominoperineal resection.
abstract: BACKGROUND
  Although minimally invasive colorectal surgery increases widely, outcomes following its use in complex operations such as the abdominoperineal resection (APR) remain indeterminate.
  
  
  METHODS
  A review of the Nationwide Inpatient Sample (2008 to 2011) of all patients undergoing elective laparoscopic or open APR was conducted. Risk-adjusted 30-day outcomes were assessed using regression modeling accounting for patient characteristics, comorbidities, and surgical procedure.
  
  
  RESULTS
  We identified 3,191 admissions meeting inclusion criteria (1,019 laparoscopic; 2,172 open). The conversion rate was 5%. Mortality was low and similar between groups (.88% vs .83%, P = .91). In-hospital complication rates were lower in the laparoscopic group (19% vs 29%, odds ratio .59, 95% confidence interval .49 to .71, P < .01), but conversion was associated with a higher rate (29% vs 18%, P < .01). Finally, a laparoscopic APR was associated with a shorter length of stay (5.3 vs 7.0 days, P < .01).
  
  
  CONCLUSIONS
  Laparoscopic APR is associated with improved outcomes and may be the preferred approach by surgeons with appropriate skills and experience.
authors.affiliation: Department of Surgery, Tripler Army Medical Center, Honolulu, HI, USA.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Schlussel
authors.affiliation: Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Lustik
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Fort Lewis, WA, USA.
authors.forename: Eric K
authors.initials: EK
authors.lastname: Johnson
authors.affiliation: Division of Colorectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA, USA.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Maykel
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, OH, USA.
authors.forename: Brad J
authors.initials: BJ
authors.lastname: Champagne
authors.affiliation: Section of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Goldberg
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Fort Lewis, WA, USA. Electronic address: harkersteele@mac.com.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Steele
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003107:Colorectal Surgery / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010502:Perineum / Q000601:surgery*; D011159:Population Surveillance; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
keywords: Abdominoperineal resection; Laparoscopy; Population database; Postoperative complications; Proctectomy