title: Reduced perioperative death following laparoscopic colorectal resection: results of an international observational study.
abstract: BACKGROUND
  Laparoscopic approaches to colorectal surgery are known to accelerate recovery but the effect on postoperative mortality is uncertain. The purpose of this study was to determine whether differences exist in postoperative mortality between patients undergoing laparoscopic and open colorectal surgery in a group of international healthcare institutions.
  
  
  METHODS
  Administrative data from 30 worldwide institutions were searched for patients who underwent elective colorectal surgical resection between January 2007 and December 2011. The primary outcome measure was 30-day-in-hospital mortality rate. Secondary outcome measures were 30-day readmission rate, length of stay, and 30-day reoperation rate.
  
  
  RESULTS
  There were 30,369 (20,641 colonic and 9728 rectal) resections recorded over the 5 years. Eight thousand eighty-six were laparoscopic (26.6%) and 22,283 (73.4%) were open. Following propensity-score matching of the laparoscopic and open cohorts, mortality was 0.5% following laparoscopic colectomy and 1.2% after conventional surgery (P < 0.001). After adjusting for differences in preoperative risk factors including gender, age, comorbidity, type of surgery and diagnosis, by matching on propensity score, laparoscopic surgery was a strong determinant of reduced 30-day mortality (odds ratio 0.44; 95% confidence interval 0.31-0.62; P < 0.001), reduced hospital stay (odds ratio 0.42, 95% confidence interval 0.39-0.45; P < 0.001), reduced readmission (odds ratio 0.78, 95% confidence interval 0.71-0.86; P < 0.001) and reduced re-operation (odds ratio 0.75, 95% confidence interval 0.65-0.76; P < 0.001).
  
  
  CONCLUSIONS
  Minimally invasive colorectal surgery is associated with reduced in-hospital mortality when compared with conventional techniques. This finding is consistent across international healthcare institutions and supports efforts to disseminate laparoscopic skills.
authors.affiliation: Department of Surgery and Cancer, Imperial College, St Mary's Hospital, Praed Street, London, W2 1NY, UK. aruna@doctors.org.uk.
authors.forename: A
authors.initials: A
authors.lastname: Munasinghe
authors.affiliation: University Hospitals Leicester, Leicester, UK.
authors.forename: B
authors.initials: B
authors.lastname: Singh
authors.affiliation: Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, USA.
authors.forename: N
authors.initials: N
authors.lastname: Mahmoud
authors.affiliation: Dr Foster Ltd, 1st Floor Jarvis House, 12 Smithfield Street, London, EC1A 9LA, UK.|School of Health Sciences, Surrey University, Surrey, UK.
authors.forename: M
authors.initials: M
authors.lastname: Joy
authors.affiliation: Department of Surgery, University of California, San Diego, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Chang
authors.affiliation: Department of Abdominal Surgery, University Hospitals Gasthuisberg, Leuven, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Penninckx
authors.affiliation: Department of Surgery and Cancer, Imperial College, St Mary's Hospital, Praed Street, London, W2 1NY, UK. omarfaiz@aol.com.|Surgical Epidemiology Trials and Outcomes Centre (SETOC), St Marks Hospital and Academic Institute, Northwick Park, Watford Road, Harrow, Middlesex, HA1 3UJ, UK. omarfaiz@aol.com.
authors.forename: O
authors.initials: O
authors.lastname: Faiz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects*; D017558:Elective Surgical Procedures; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D012086:Reoperation; D018570:Risk Assessment; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
keywords: Colorectal; Laparoscopy; Minimally invasive surgery