Laparoscopic resection for inflammatory bowel disease: outcomes from a nationwide sample

Abstract

Background and aims: A significant proportion of patients with inflammatory bowel diseases (IBD) require surgery. While the majority of these are open procedures (OP), there is recent interest in laparoscopic resection (LS). There are no nationwide comparison of outcomes between LS and OP.

Methods: We used data from the Nationwide Inpatient Sample 2004 and identified patients with IBD who underwent ileocolonic/colonic resection using appropriate ICD-9 codes. Procedures were considered to be laparoscopic if they had concomitant codes for laparoscopy (International Classification of Diseases, Ninth edition, clinical modification 54.21/54.51). Multivariate regression was performed to identify independent predictors and outcomes.

Results: There were 209,206 IBD hospitalizations included in the study among whom, 884 underwent laparoscopic resections (5.3%). On multivariate analysis, fistulizing disease (odds ratio (OR) 0.35, 95% confidence interval (CI) 0.21-0.59) and emergent admission (OR 0.59, 95% CI 0.39-0.90) were negative while annual hospital IBD surgical volume of >50 procedures (OR 2.0, 95% CI 1.14-3.52) were positively associated with LS. LS was associated with a significantly lower proportion of postoperative complications (27.1% vs 35.4%, p < 0.001) and shorter postoperative length of stay compared to OP (-1.9 days, 95% CI -3.2 to -0.6 days). Propensity score adjustment for nonrandom allocation of patients into the treatment groups neutralized the OR for postoperative complication (OR 0.82) but not length of stay (-1.7 days).

Conclusion: LS had no increase in rate of complications and was associated with a shorter postoperative length of stay.