Minimally invasive technique leads to decreased morbidity and mortality in small bowel resections compared to an open technique: an ACS-NSQIP identified target for improvement

J Gastrointest Surg. 2014 Jun;18(6):1171-5. doi: 10.1007/s11605-014-2493-5. Epub 2014 Apr 2.

Abstract

Background: We hypothesize that currently minimally invasive techniques are underutilized, leading to unnecessary morbidity and mortality. The objective of the study was to compare morbidity and mortality rates in patients receiving a minimally invasive (MIS) small bowel resection to patients receiving an open (OP) small bowel resection.

Methods: Patients in the National Surgical Quality Improvement Program (NSQIP) database who underwent a small bowel resection between 2007 and 2011 were enrolled in the study and grouped whether they received a MIS procedure (n = 1,780) or an OP procedure (n = 17,701). The primary endpoint of the study was to evaluate the difference in morbidity (excluding mortality) and mortality in patients undergoing a minimally invasive procedure compared to an open procedure.

Results: The MIS technique is utilized in 9.0 % of patients undergoing a small bowel resection. Significantly lower mortality rate (2.9 vs. 8.2 %; p < 0.001) and mean morbidity rate (1.7 vs. 4.3 %; p < 0.001) were demonstrated in the MIS group. Significantly lower mean major morbidity rate (1.4 vs. 3.9 %; p < 0.001) and mean minor morbidity rate (2.6 vs. 5.5 %; p < 0.001) were demonstrated in the MIS group.

Conclusion: The MIS technique in small bowel resections appears to be underutilized, with only 9.0 % of patients in need of a small bowel resection undergo the minimally invasive approach. Wider utilization of the MIS technique could lead to significantly decreased morbidity and mortality.

Publication types

  • Comparative Study

MeSH terms

  • Blood Transfusion
  • Databases, Factual
  • Female
  • Humans
  • Intestine, Small / surgery*
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / mortality
  • Minimally Invasive Surgical Procedures / statistics & numerical data
  • Postoperative Complications / epidemiology*
  • Quality Improvement*
  • Sepsis / epidemiology*
  • Surgical Wound Infection / epidemiology
  • United States / epidemiology