title: Laparoscopic vs open partial colectomy in elderly patients: Insights from the American College of Surgeons - National Surgical Quality Improvement Program database.
abstract: OBJECTIVE
  To compare the outcomes between the laparoscopic and open approaches for partial colectomy in elderly patients aged 65 years and over using the American College of Surgeons - National Surgical Quality Improvement Program (ACS NSQIP) database.
  
  
  METHODS
  The ACS NSQIP database for the years 2005-2011 was queried for all patients 65 years and above who underwent partial colectomy. 1:1 propensity score matching using the nearest- neighbor method was performed to ensure both groups had similar pre-operative comorbidities. Outcomes including post-operative complications, length of stay and mortality were compared between the laparoscopic and open groups. χ(2) and Fisher's exact test were used for discrete variables and Student's t-test for continuous variables. P < 0.05 was considered significant and odds ratios with 95%CI were reported when applicable.
  
  
  RESULTS
  The total number of patients in the ACS NSQIP database of the years 2005-2011 was 1777035. We identified 27604 elderly patients who underwent partial colectomy with complete data sets. 12009 (43%) of the cases were done laparoscopically and 15595 (57%) were done with open. After propensity score matching, there were 11008 patients each in the laparoscopic (LC) and open colectomy (OC) cohorts. The laparoscopic approach had lower post-operative complications (LC 15.2%, OC 23.8%, P < 0.001), shorter length of stay (LC 6.61 d, OC 9.62 d, P < 0.001) and lower mortality (LC 1.6%, OC 2.9%, P < 0.001).
  
  
  CONCLUSIONS
  Even after propensity score matching, elderly patients in the ACS NSQIP database having a laparoscopic partial colectomy had better outcomes than those having open colectomies. In the absence of specific contraindications, elderly patients requiring a partial colectomy should be offered the laparoscopic approach.
authors.affiliation: Umashankkar Kannan, Vemuru Sunil K Reddy, Amar N Mukerji, Vellore S Parithivel, Ajay K Shah, Brian F Gilchrist, Daniel T Farkas, Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, NY 10457, United States.
authors.forename: Umashankkar
authors.initials: U
authors.lastname: Kannan
authors.affiliation: Umashankkar Kannan, Vemuru Sunil K Reddy, Amar N Mukerji, Vellore S Parithivel, Ajay K Shah, Brian F Gilchrist, Daniel T Farkas, Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, NY 10457, United States.
authors.forename: Vemuru Sunil K
authors.initials: VS
authors.lastname: Reddy
authors.affiliation: Umashankkar Kannan, Vemuru Sunil K Reddy, Amar N Mukerji, Vellore S Parithivel, Ajay K Shah, Brian F Gilchrist, Daniel T Farkas, Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, NY 10457, United States.
authors.forename: Amar N
authors.initials: AN
authors.lastname: Mukerji
authors.affiliation: Umashankkar Kannan, Vemuru Sunil K Reddy, Amar N Mukerji, Vellore S Parithivel, Ajay K Shah, Brian F Gilchrist, Daniel T Farkas, Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, NY 10457, United States.
authors.forename: Vellore S
authors.initials: VS
authors.lastname: Parithivel
authors.affiliation: Umashankkar Kannan, Vemuru Sunil K Reddy, Amar N Mukerji, Vellore S Parithivel, Ajay K Shah, Brian F Gilchrist, Daniel T Farkas, Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, NY 10457, United States.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Shah
authors.affiliation: Umashankkar Kannan, Vemuru Sunil K Reddy, Amar N Mukerji, Vellore S Parithivel, Ajay K Shah, Brian F Gilchrist, Daniel T Farkas, Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, NY 10457, United States.
authors.forename: Brian F
authors.initials: BF
authors.lastname: Gilchrist
authors.affiliation: Umashankkar Kannan, Vemuru Sunil K Reddy, Amar N Mukerji, Vellore S Parithivel, Ajay K Shah, Brian F Gilchrist, Daniel T Farkas, Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, NY 10457, United States.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Farkas
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003082:Colectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Colectomy; Elderly; Laparoscopic; National Surgical Quality Improvement Program; Outcomes