Early post-operative outcomes in adults undergoing minimally invasive versus open emergency colorectal surgery: A retrospective cohort study of the ACS-NSQIP 2016-2022.

Abstract

Minimally invasive surgery (MIS) has become common practice in elective colectomy; however, in emergent settings, this is less common and requires further research on safety and efficacy. The aim of this study was to compare MIS and open approaches for emergency colectomy. Adults who underwent emergency colectomy for diverticular disease, colorectal malignancy or inflammatory bowel disease between 2016 and 2022 were identified in the American College of Surgeons National Surgical Quality Improvement Program. The primary outcome was overall 30-day post-operative major morbidity-a composite outcome that included variables such as mortality and venous thromboembolism. Secondary outcomes were 30-day post-operative mortality, septic complications, wound complications and length of stay (LOS). Multivariable regression models were fit for each outcome. In total, 82,142 patients were identified who underwent emergency colectomy, of which 24,050 patients underwent MIS (29.4%). In total, 27,206 patients (33.1%) experienced the primary outcome of overall in-hospital post-operative morbidity, with significantly more patients in the open group experiencing this outcome (39.3% vs. 18.3%, odds ratio [OR] 0.57, 95% confidence intervals [CI] 0.54-0.59, p < 0.001). MIS patients had significantly lower risk of mortality (OR 0.54, 95% CI 0.48-0.60), septic complications (OR 0.57, 95% CI 0.54-0.61) and wound complications (OR 0.53, 95% CI 0.51-0.56). Post-operative LOS was 2.22 days shorter in the MIS group (95% CI -2.32 to -2.13, p < 0.001). Emergency colectomy via MIS is associated with a decreased risk of post-operative morbidity and mortality as compared to open surgery. While MIS is increasingly prevalent in elective settings, these data illustrate potential benefits in the emergent setting.