Minimally Invasive Emergent Colorectal Surgery Tied to Better Outcomes

A minimally invasive approach to emergent colorectal surgery was associated with better outcomes, including for older adults, a retrospective study found.

After adjusting for demographics, BMI, and primary surgical site, those who underwent minimally invasive surgery (MIS) were more likely to be discharged home (OR 2.08, 95% CI 1.82-2.37), were less likely to have an adverse event (OR 0.51, 95% CI 0.46-0.58), and had a shorter length of stay (mean difference in days -2.36, 95% CI -2.93 to -1.79; P<0.001 for all) compared with those who underwent open surgery, reported Vlad Simianu, MD, MPH, of the Virginia Mason Medical Center in Seattle, and colleagues, writing in the American Journal of Surgery.

In addition, an age-stratified analysis showed that older patients were also less likely to have an adverse event with the MIS approach, and those ages 65 to 74 were more likely to be discharged home:

• Adverse event for ages 65 to 74: OR 0.66 (95% CI 0.52-0.86)
• Adverse event for ages 75 and up: OR 0.68 (95% CI 0.54-0.87)
• Discharge to home for patients ages 65 to 74: OR 1.47 (95% CI 1.12-1.93)

Data on use of MIS in emergent colorectal surgery settings are “sparse,” especially for older adults, who are more likely to need emergent surgery, but “suggest that MIS techniques … are safe and effective,” Simianu’s group wrote.

Of note, increased use of MIS was associated with surgeries occurring during standard operating hours compared with overnight hours. “Potential barriers to MIS use may come in the form of access to equipment or experienced teams with MIS technology based on the time of day the procedure is performed,” Simianu and colleagues wrote.

“The authors correctly advise that overnight operating room teams may not be familiar with the equipment in late hours, something that any operative surgeon has struggled with and would impact future decision-making,” Allen Kamrava, MD, of Cedars-Sinai Medical Center in Los Angeles, told MedPage Today.

“If there is any variable that may make MIS ‘less’ safe, however subjective or improper biases, even if non-MIS surgery increases the length of stay, safety comes first,” added Kamrava, who was not involved with the study.

For their study, Simianu and colleagues examined data from the Surgical Care Outcomes Assessment Program on 6,913 adults (mean age 64) who underwent emergent colorectal surgery across 50 hospitals from 2011 to 2019. Patients were stratified into three age groups: younger than 65 (n=3,444), ages 65 to 74 (n=1,649), and ages 75 and up (n=1,820). Any cases that were started via laparoscopic, laparoscopic hand-assist, or robotic approaches were included in the MIS group.

Among all included patients, 23.4% underwent MIS. MIS patients were more likely to be younger than 65 (55.1% vs 48.2%), have an American Society of Anesthesia (ASA) score below III at surgery (46.9% vs 29.8%), and be privately insured (61.4% vs 55.6%) compared with those who underwent open surgery.

Overall, about 25% of patients underwent surgery for diverticulitis, 19% for cancer, and 50% for “other” causes. Over three-quarters had a primary abdominal surgical site.

Simianu and colleagues noted that several important confounders, such as patient frailty and surgeons’ experience with MIS — which could influence outcomes — were not assessed.