Laparoscopically assisted vs. open elective colonic and rectal resection: a comparison of outcomes in English National Health Service Trusts between 1996 and 2006

Dis Colon Rectum. 2009 Oct;52(10):1695-704. doi: 10.1007/DCR.0b013e3181b55254.

Abstract

Purpose: This study was designed to compare outcomes after elective laparoscopic and conventional colorectal surgery over a ten-year period using data from the English National Health Service Hospital Episode Statistics database.

Methods: All elective colonic and rectal resections carried out in English Trusts between 1996 and 2006 were included. Univariate and multivariate analyses were used to compare 30 and 365-day mortality rates, 28-day readmission rates, and length of stay between laparoscopic and open surgery.

Results: Between the study dates 3,709 of 192,620 (1.9%) elective colonic and rectal resections were classified as laparoscopically assisted procedures. The 30-day and 365-day mortality rates were lower after laparoscopic resection than after open surgery (P < 0.05). After correction for age, gender, diagnosis, operation type, comorbidity, and social deprivation, laparoscopic surgery was a strong determinant of reduced 30-day (odds ratio, 0.57; 95% confidence interval, 0.44-0.74; P < 0.001) and one-year (odds ratio, 0.53; 95% confidence interval, 0.42-0.67; P < 0.001) mortality. Similarly, multivariate analysis confirmed that laparoscopic surgery was independently associated with reduced hospital stay (P < 0.001). Patients who received rectal procedures for malignancy, however, were more likely to be readmitted if laparoscopy rather than by a traditional method was used (11.9% vs. 9.1%, P = 0.003).

Conclusion: In the present study, patients selected for laparoscopic colorectal surgery were associated with reduced postoperative mortality when compared with those undergoing the conventional technique. This finding merits further investigation.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged, 80 and over
  • Colorectal Neoplasms / mortality
  • Colorectal Neoplasms / surgery*
  • Digestive System Surgical Procedures / methods*
  • Digestive System Surgical Procedures / mortality
  • England / epidemiology
  • Female
  • Hospital Mortality
  • Humans
  • Laparoscopy / methods*
  • Laparoscopy / mortality
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Regression Analysis
  • Treatment Outcome