Laparoscopic vs open partial colectomy in elderly patients: Insights from the American College of Surgeons - National Surgical Quality Improvement Program database

Table 1 Preoperative characteristics of elderly patients undergoing partial colectomy before propensity score matching n (%)

Characteristics	Laparoscopic colectomy(n = 12009)	Open colectomy (n = 15595)	P value
Age, mean ± SD	75.94 ± 7.15	74.87 ± 6.92	< 0.001
BMI, mean ± SD	27.30 ± 6.38	27.17 ± 7.09	< 0.001
Gender			0.416
Female	7401 (61.6)	9536 (61.1)
Male	4608 (38.4)	6059 (38.9)
Procedure			< 0.001
Right partial colectomy	3122 (25.9)	3773 (24.2)
Left partial colectomy	6614 (55.1)	8492 (54.5)
Sigmoidectomy	2273 (19.0)	3330 (21.3)
Indication			< 0.001
Benign	4769 (39.7)	5447 (34.9)
Malignant	4544 (37.8)	7454 (47.8)
Unknown	2696 (22.4)	2694 (17.3)
ASA class
I	155 (1.2)	115 (0.7)
II	5418 (45.2)	4960 (31.8)
III	5956 (49.6)	9225 (59.2)
IV	477 (4.0)	1278 (8.2)
V	3 (0.02)	17 (0.1)
ASA III, IV or V	6436 (53.6)	10520 (67.5)	< 0.001
Alcohol	359 (2.9)	408 (2.6)	0.061
Current smoker	1062 (8.8)	1689 (10.8)	< 0.001
Cardiac diseases	8489 (70.7)	11350 (72.8)	< 0.001
Hypertension	8232 (68.5)	10936 (70.1)	0.005
History of CHF	119 (1.0)	297 (1.9)	< 0.001
History of MI	56 (0.5)	169 (1.1)	< 0.001
History of angina	80 (0.7)	200 (1.3)	< 0.001
History of PCI	957 (8.0)	1431 (9.2)	< 0.001
History of PCS	959 (8.0)	1495 (9.6)	< 0.001
Pulmonary diseases	836 (7.0)	1519 (9.7)	< 0.001
Dyspnea	1600 (13.3)	2723 (17.4)	< 0.001
History of COPD	821 (6.8)	1428 (9.2)	< 0.001
Ventilator dependent	4 (0.02)	58 (0.4)	< 0.001
Pneumonia	20 (0.2)	71 (0.5)	< 0.001
Neurological disease	994 (8.3)	1689 (10.8)	< 0.001
History of CVA	347 (2.9)	613 (3.9)	< 0.001
History of CVANO	355 (3.0)	591 (3.8)	< 0.001
History of TIA	516 (4.3)	801 (5.1)	0.002
History of tumor CNS	11 (0.1)	18 (0.1)	0.545
Renal diseases	62 (0.5)	173 (1.1)	< 0.001
History of renal failure	15 (0.1)	56 (0.4)	< 0.001
Dialysis dependent	52 (0.4)	137 (0.9)	< 0.001
Bleeding disorders	487 (4.1)	1009 (6.5)	< 0.001
Steroid use1	365 (3.0)	580 (3.7)	0.002
Diabetes	3166 (26.4)	3193 (20.5)	< 0.001

¹Use of steroid in the 30 d prior to surgery for a chronic medical condition. BMI: Body mass index; ASA: American Society of Anesthesiologists; CHF: Congestive heart failure; MI: Myocardial infarction; PCI: Percutaneous coronary intervention; PCS: Previous cardiac surgery; PVD: Peripheral vascular disease; COPD: Chronic pulmonary obstructive disease; CVA: Cerebrovascular accident with neurological deficit; CVANO: Cerebrovascular accident without neurological deficit; TIA: Transient ischemic attack; Tumor CNS: Tumor involving central nervous system.

Table 2 Preoperative characteristics of elderly patients undergoing partial colectomy after propensity score matching n (%)

Characteristics	Laparoscopic colectomy(n = 11008)	Open colectomy (n = 11008)	P value
Age
mean ± SD	75.12 ± 6.97	75.21 ± 6.98	0.857
median ± IQR	74 ± 11	74 ± 12	0.332
BMI (mean ± SD)	27.31 ± 6.42	27.23 ± 7.05	0.368
Gender			0.021
Female	6685 (60.7)	6852 (62.2)
Male	4323 (39.3)	4156 (37.8)
Procedure			0.013
Right partial colectomy	2549 (23.2)	2736 (24.8)	0.003
Left partial colectomy	6237 (56.7)	6099 (55.4)	0.061
Sigmoidectomy	2222 (20.1)	2173 (19.8)	0.409
Indication			< 0.001
Benign	4361 (39.6)	3966 (36.0)
Malignant	4193 (38.1)	5431 (49.3)
Unknown	2454 (22.3)	1611 (14.6)
ASA class
I	127 (1.1)	110 (1.0)
II	4563 (41.5)	4563 (41.5)
III	5852 (53.2)	5673 (51.5)
IV	463 (4.2)	658 (6.0)
V	3 (0.02)	4 (0.03)
ASA III, IV or V	6318 (57.4)	6335 (57.5)	0.817
Alcohol	341 (3.0)	289 (2.6)	0.036
Current smoker	1051 (9.5)	993 (9.0)	0.178
Cardiac diseases	7905 (71.8)	7845 (71.3)	0.370
Hypertension	7654 (69.5)	7614 (69.2)	0.559
History of CHF	116 (1.1)	134 (1.2)	0.252
History of MI	51 (0.5)	57 (0.5)	0.563
History of angina	75 (0.6)	86 (0.7)	0.384
History of PCI	902 (8.2)	807 (7.3)	0.017
History of PCS	924 (8.4)	894 (8.1)	0.463
Pulmonary diseases	815 (7.4)	778 (7.1)	0.336
Dyspnea	1526 (13.7)	1513 (13.7)	0.432
History of COPD	801 (7.3)	758 (6.9)	0.259
Ventilator dependent	3 (0.02)	3 (0.02)	1.000
Pneumonia	18 (0.2)	24 (0.2)	0.354
Neurological disease	921 (8.4)	896 (8.1)	0.540
History of CVA	333 (3.0)	305 (2.8)	0.261
History of CVANO	323 (2.9)	307 (2.8)	0.518
History of TIA	347 (3.2)	353 (3.2)	0.818
History of tumor CNS	10 (0.1)	6 (0.1)	0.317
Renal diseases	57 (0.5)	55 (0.5)	0.850
History of renal failure	12 (0.1)	13 (0.1)	0.841
Dialysis dependent	49 (0.4)	48 (0.4)	0.919
Bleeding disorders	466 (4.2)	425 (3.9)	0.161
Steroid use1	353 (3.2)	318 (2.9)	0.170
Diabetes	2077 (18.9)	2040 (18.5)	0.522

¹Use of steroid in the 30 d prior to surgery for a chronic medical condition. BMI: Body mass index; ASA: American Society of Anesthesiologists; CHF: Congestive heart failure; MI: Myocardial infarction; PCI: Percutaneous coronary intervention; PCS: Previous cardiac surgery; PVD: Peripheral vascular disease; COPD: Chronic pulmonary obstructive disease; CVA: Cerebrovascular accident with neurological deficit; CVANO: Cerebrovascular accident without neurological deficit; TIA: Transient ischemic attack; Tumor CNS: Tumor involving central nervous system.

Table 3 Intraoperative characteristics of elderly patients undergoing partial colectomy after propensity score matching

Characteristics	Laparoscopic colectomy(n = 11008)	Open colectomy (n = 11008)	P value
Operative time (min), mean ± SD	151.75 ± 66.15	143.56 ± 78.60	< 0.001
Anesthesia time (min), mean ± SD	209.47 ± 78.54	200.72 ± 91.29	< 0.001
Blood transfusions, n (%)	250 (2.3)	307 (2.8)	< 0.001
Intraoperative occurrence			0.143
Cardiac arrest	1	5
Myocardial infarction	3	5
Unplanned intubation	5	11

Table 4 Post-operative outcomes of elderly patients undergoing partial colectomy after propensity score matching n (%)

Characteristics	Laparoscopic colectomy(n = 11008)	Open colectomy(n = 11008)	P value	OR/CI
Overall complications1	1676 (15.2)	2622 (23.8)	< 0.001	1.56 (1.48-1.65)
Cardiac complications	109 (1.0)	160 (1.5)	0.002	1.47 (1.15-1.87)
Cardiac arrest	50 (0.4)	80 (0.7)	0.008	1.60 (1.13-2.28)
Myocardial infarction	71 (0.6)	88 (0.8)	0.176	1.24 (0.91-1.69)
Pulmonary complications	489 (4.4)	729 (6.6)	< 0.001	1.49 (1.33-1.67)
Pneumonia	239 (2.2)	375 (3.4)	< 0.001	1.57 (1.34-1.84)
Unplanned intubation	217 (2.0)	326 (3.0)	< 0.001	1.50 (1.27-1.78)
Ventilated for more than 48 h	165 (1.5)	294 (2.7)	< 0.001	1.78 (1.48-2.15)
Pulmonary emboli	69 (0.6 )	87 (0.8)	0.148	1.26 (0.92-1.73)
Deep venous thrombosis	97 (0.9)	179 (1.6)	< 0.001	1.85 (1.44-2.36)
Renal complications	421 (3.8)	656 (6.0)	< 0.001	1.56 (1.38-1.76)
Progressive renal insufficiency	54 (0.4)	98 (0.9)	< 0.001	1.81 (1.30-2.53)
Acute renal failure	50 (0.4)	72 (0.7)	0.046	1.44 (1.01-2.06)
Urinary tract infection	339 (3.1)	524 (4.8)	< 0.001	1.55 (1.35-1.77)
Infections	1170 (10.6)	1951 (17.7)	< 0.001	1.67 (1.56-1.78)
Sepsis	274 (2.5)	468 (4.3)	< 0.001	1.71 (1.46-1.98)
Septic shock	156 (1.4)	284 (2.6)	< 0.001	1.82 (1.50-2.21)
Superficial incisional infection	582 (5.3)	968 (8.8)	< 0.001	1.66 (1.51-1.84)
Deep incisional infection	96 (0.9)	150 (1.4)	0.001	1.56 (1.21-2.02)
Organ space infection	206 (1.9)	347 (3.2)	< 0.001	1.68 (1.42-1.99)
Wound disruption	84 (0.8)	144 (1.3)	< 0.001	1.71 (1.31-2.24)
Return to operating room	451 (4.1)	588 (5.3)	< 0.001	1.30 (1.16-1.47)
Length of stay (d), mean ± SD	6.61 ± 6.73	9.62 ± 8.33	< 0.001	-
30-d mortality	173 (1.6)	316 (2.9)	< 0.001	1.83 (1.52-2.19)

¹Any one of cardiac, pulmonary, renal or infectious complications.