title: A nationwide assessment comparing nonelective open with minimally invasive complex colorectal procedures.
abstract: OBJECTIVE
  The use of minimally invasive colorectal surgery has increased greatly for both benign and malignant disease. Studies evaluating complex procedures have been largely limited to elective indications. We aimed to compare the outcome of a laparoscopic with an open transverse (TC) and total abdominal colectomy (TAC) in the nonelective setting.
  
  
  METHODS
  Comparative analysis was made using the Nationwide Inpatient Sample (2008-11) of patients undergoing a nonelective TC or TAC identified by ICD-9-CM procedure codes. The risk-adjusted 30-day outcome was assessed using regression modelling accounting for patient characteristics, comorbidity and surgical procedure.
  
  
  RESULTS
  We identified 7261 admissions including 818 laparoscopic and 6443 open procedures. The mean age of the population was 65 ± 17 years and patients in the laparoscopic group were younger (56 ± 20 vs. 66 ± 17 years; P < 0.05). The rate of a single complication was lower in the laparoscopic group (26% vs. 38%; P < 0.01), but this did not remain significant following a logistic regression analysis. Mortality was significantly lower in the laparoscopic group (3.1% vs. 17%; P < 0.01) and this remained true after adjusting for covariates (OR = 0.62; P < 0.05). Laparoscopic cases were associated with a shorter median length of stay (10 vs. 13 days; P < 0.01) and hospital charge ($75,758 vs. $98,833; P < 0.01).
  
  
  CONCLUSIONS
  A nonelective laparoscopic TC or TAC is associated with an equivalent complication rate and lower mortality compared with an open operation. The results should encourage surgeons with the appropriate skills to consider a laparoscopic approach for nonelective pathology requiring a complex colectomy.
authors.affiliation: Department of Surgery, Brian Allgood Army Community Hospital, Honolulu, HI, USA.
authors.forename: A T
authors.initials: AT
authors.lastname: Schlussel
authors.affiliation: Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Lustik
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Fort Lewis, WA, USA.
authors.forename: E K
authors.initials: EK
authors.lastname: Johnson
authors.affiliation: Division of Colorectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Maykel
authors.affiliation: Division of Colorectal Surgery, University Hospitals-Case Medical Center, Cleveland, OH, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Champagne
authors.affiliation: Division of Colorectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Damle
authors.affiliation: Division of Colorectal Surgery, Temple University, Philadelphia, PA, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Ross
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Fort Lewis, WA, USA.
authors.forename: S R
authors.initials: SR
authors.lastname: Steele
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D003106:Colon / Q000601:surgery; D003108:Colonic Diseases / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
keywords: Nonelective; colorectal surgery; emergent; laparoscopy