Hand-assisted laparoscopic vs open colectomy: an assessment from the American College of Surgeons National Surgical Quality Improvement Program procedure-targeted cohort.
BACKGROUND
Perioperative outcomes of patients who underwent hand-assisted colorectal laparoscopic (HALS) vs open colectomy were compared using recently released procedure-targeted database.


METHODS
Review was conducted using the 2012 colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database. Patients were classified into 2 groups according to final surgical approach: HALS vs open (planned). Groups were matched (1:1) based on age, gender, body mass index, surgical procedure, diagnosis, American Society of Anesthesiologists score, and wound classification. Multivariate logistic regression analysis was conducted for group comparison.


RESULTS
Of 7,303 patients, 1,740 patients were matched in each group. Open group had higher proportion of patients with preoperative dyspnea (P = .01), ascites (P = .01), weight loss (P < .001), smoking history (P = .04), and increased work relative value units (P < .001). After adjusting for difference in baseline comorbidities, overall morbidity, superficial, deep, and organ-space surgical site infection, urinary tract infection, ileus, reoperation, readmission, and hospital stay were significantly higher in open group (P < .05).


CONCLUSIONS
National Surgical Quality Improvement Program targeted-data demonstrated several advantages of HALS compared with open colonic resection including shorter hospital stay and lower complication rate. Further adoption of HALS technique as a bridge to straight laparoscopy or tool in difficult cases can positively impact the short-term outcomes after colectomy when compared with open technique.
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A-30, Cleveland, OH 44195, USA.
Cigdem
C
Benlice
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A-30, Cleveland, OH 44195, USA.
Meagan
M
Costedio
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A-30, Cleveland, OH 44195, USA.
Luca
L
Stocchi
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A-30, Cleveland, OH 44195, USA.
Maher A
MA
Abbas
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A-30, Cleveland, OH 44195, USA. Electronic address: gorgune@ccf.org.
Emre
E
Gorgun
D000367:Age Factors; D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003093:Colitis, Ulcerative / Q000601:surgery; D003110:Colonic Neoplasms / Q000601:surgery; D016001:Confidence Intervals; D003424:Crohn Disease / Q000601:surgery; D016208:Databases, Factual; D004241:Diverticulum, Colon / Q000601:surgery; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011379:Prognosis; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016896:Treatment Outcome
Colorectal surgery; Hand-assisted laparoscopic surgery; NSQIP; Procedure-targeted database