The Impact of Operative Approach on Postoperative Complications Following Colectomy for Colon Caner.
Colectomy is one of the most common major abdominal procedures performed in the USA. A better understanding of risk factors and the effect of operative approach on adverse postoperative outcomes may significantly improve quality of care.



Adult patients with a primary diagnosis of colon cancer undergoing colectomy were selected from the National Surgical Quality Improvement Program 2013-2015 targeted colectomy database. Patients were stratified into five groups based on specific operative approach. Univariate and multivariate analyses were used to compare the five groups and identify risk factors for 30-day anastomotic leak, readmission, and mortality.



In total, 25,097 patients were included in the study, with a 3.32% anastomotic leak rate, 1.20% mortality rate, and 9.57% readmission rate. After adjusting for other factors, open surgery and conversion to open significantly increased the odds for leak, mortality, and readmission compared to laparoscopy. Additionally, smoking and chemotherapy increased the risk for leak and readmission, while total resection was associated with increased mortality and leak.



Operative approach and several other potentially modifiable perioperative factors have a significant impact on risk for adverse postoperative outcomes following colectomy. To improve quality of care for these patients, efforts should be made to identify and minimize the influence of such risk factors.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Benedetto
B
Mungo
Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave K4/752, Madison, WI, 53792-7375, USA.
Christina M
CM
Papageorge
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Miloslawa
M
Stem
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Daniela
D
Molena
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. lidor@surgery.wisc.edu.|Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave K4/752, Madison, WI, 53792-7375, USA. lidor@surgery.wisc.edu.
Anne O
AO
Lidor
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D003110:Colonic Neoplasms / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology