title: Colorectal surgery in Parkinson's disease--outcomes and predictors of mortality.
abstract: OBJECTIVE
  Although diseases of the lower gastrointestinal tract are common in patients with Parkinson's disease, there is a paucity of data regarding postoperative outcomes after colorectal surgery.
  
  
  METHODS
  The Nationwide Inpatient Sample database (2007-2011) was utilized to analyze outcomes in patients with Parkinson's disease (PD) undergoing colorectal surgery. Main outcomes were risk-adjusted inpatient morbidity, mortality, hospital charge, and length of hospital stay.
  
  
  RESULTS
  A total of 6490 patients were identified. Utilization of laparoscopic surgery in Parkinson's patients has progressively increased in frequency over the latest 5 years analyzed. The most common diagnoses were colorectal malignancy (39 %) and intestinal obstruction (20 %). Right hemicolectomy (37 %) and sigmoidectomy (30 %) were the most common operations. Laparoscopy was used in 18 % of Parkinson's patients and most commonly in the elective setting. 54.3 % of Parkinson's patients had emergency surgery compared to 38.6 % in non-Parkinson's. Overall morbidity and mortality were significantly lower after laparoscopic surgery compared to open (20 vs. 25 % and 2.1 vs. 6.6 %, respectively). Length of stay was significantly shorter (OR -1.86; p < 0.01) for laparoscopic operations, but there were no significant differences in risk-adjusted outcomes between laparoscopic and open groups.
  
  
  CONCLUSIONS
  PD patients have high rates of morbidity and mortality after colorectal surgery; this may be because more than half of all patients in this population undergo emergent surgery. The laparoscopic approach appears to have short-term benefits in this patient population.
authors.affiliation: Department of Surgery, Irvine School of Medicine, University of California, Irvine, Orange, CA, USA.
authors.forename: Grace S
authors.initials: GS
authors.lastname: Hwang
authors.forename: Monica T
authors.initials: MT
authors.lastname: Young
authors.forename: Mark H
authors.initials: MH
authors.lastname: Hanna
authors.forename: Gopal
authors.initials: G
authors.lastname: Menon
authors.forename: Michael
authors.initials: M
authors.lastname: Phelan
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Carmichael
authors.forename: Steven
authors.initials: S
authors.lastname: Mills
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
authors.forename: Neal
authors.initials: N
authors.lastname: Hermanowicz
authors.forename: Alessio
authors.initials: A
authors.lastname: Pigazzi
mesh_terms: D000368:Aged; D003107:Colorectal Surgery / Q000401:mortality*; D003710:Demography; D017558:Elective Surgical Procedures / Q000401:mortality; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010300:Parkinson Disease / Q000401:mortality* / Q000601:surgery*; D011182:Postoperative Care; D016896:Treatment Outcome