Minimally-invasive approach to emergent colorectal surgery in aging adults: A report from the Surgical Care Outcomes Assessment Program
Despite known benefits of minimally invasive surgery(MIS) in elective settings, MIS use in emergency colorectal surgery(CRS) is limited. Older adults are more likely to require emergent CRS, and MIS is used less frequently with increasing age. A retrospective cohort was constructed of emergent CRS c...
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| Veröffentlicht in: | The American journal of surgery 2022-08, Vol.224 (2), p.751-756 |
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| creator | Charboneau, Alex Feldmann, Timothy Kanneganti, Shalini Kaplan, Jennifer A. Moonka, Ravi Sillah, Arthur Thirlby, Richard C. Simianu, Vlad V. |
| description | Despite known benefits of minimally invasive surgery(MIS) in elective settings, MIS use in emergency colorectal surgery(CRS) is limited. Older adults are more likely to require emergent CRS, and MIS is used less frequently with increasing age.
A retrospective cohort was constructed of emergent CRS cases performed between 2011 and 2019. Discharge(DC) disposition, adverse events, and length of stay(LOS) between MIS and open surgery were compared and stratified by age. Adjustment was made for selected confounders using inverse probability weighting.
Of 6913 emergent CRS cases across 50 hospitals, 1616(23%) were approached MIS. MIS cases were more likely [OR(95%CI)] to DC home [ |
| doi_str_mv | 10.1016/j.amjsurg.2022.03.055 |
| format | Article |
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A retrospective cohort was constructed of emergent CRS cases performed between 2011 and 2019. Discharge(DC) disposition, adverse events, and length of stay(LOS) between MIS and open surgery were compared and stratified by age. Adjustment was made for selected confounders using inverse probability weighting.
Of 6913 emergent CRS cases across 50 hospitals, 1616(23%) were approached MIS. MIS cases were more likely [OR(95%CI)] to DC home [<65yo:1.7(1.3,2.2); 65–74:1.5(1.1,1.9); 75+:1.2(0.9,1.5)] and have fewer adverse events [<65yo:0.6(0.5,0.8); 65–74:0.7(0.5,0.9); 75+:0.7(0.5,0.9)]. LOS was shorter [Mean difference in days(95%CI)] [<65yo: 2.2(-2.9,-1.4); 65–74: 0.9(-2.7,1.0); 75+: 0.7(-1.7,0.2)].
MIS in emergent CRS is associated with increased DC to home, fewer adverse events, and shorter LOS. Benefits persisted with age after adjustment, suggesting an opportunity for improved MIS delivery in older adults.
•Less than ¼ of emergent colorectal cases are approached minimally invasively.•MIS use in emergency CRS was incrementally lower in older adults, no matter the time of day.•MIS was associated with improved outcomes in all patients, including older adults.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2022.03.055</identifier><identifier>PMID: 35437154</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Abdomen ; Adults ; Adverse events ; Age ; Age groups ; Aging ; Cancer ; Colorectal ; Colorectal surgery ; Elderly ; Emergency surgery ; Fistula ; Health services ; Hospitals ; Hypotheses ; Inflammatory bowel disease ; Laparoscopy ; Length of stay ; Minimally invasive surgery ; Older people ; Patients ; Surgery ; Variables</subject><ispartof>The American journal of surgery, 2022-08, Vol.224 (2), p.751-756</ispartof><rights>2022 Elsevier Inc.</rights><rights>Copyright © 2022 Elsevier Inc. All rights reserved.</rights><rights>2022. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c341t-c3f3fdf73cacb283cda7fe16e4c4b26f5bbccc86447a914d6dfd0d381396e0ba3</cites><orcidid>0000-0002-9146-5174</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2690990936?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35437154$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Charboneau, Alex</creatorcontrib><creatorcontrib>Feldmann, Timothy</creatorcontrib><creatorcontrib>Kanneganti, Shalini</creatorcontrib><creatorcontrib>Kaplan, Jennifer A.</creatorcontrib><creatorcontrib>Moonka, Ravi</creatorcontrib><creatorcontrib>Sillah, Arthur</creatorcontrib><creatorcontrib>Thirlby, Richard C.</creatorcontrib><creatorcontrib>Simianu, Vlad V.</creatorcontrib><title>Minimally-invasive approach to emergent colorectal surgery in aging adults: A report from the Surgical Care Outcomes Assessment Program</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Despite known benefits of minimally invasive surgery(MIS) in elective settings, MIS use in emergency colorectal surgery(CRS) is limited. Older adults are more likely to require emergent CRS, and MIS is used less frequently with increasing age.
A retrospective cohort was constructed of emergent CRS cases performed between 2011 and 2019. Discharge(DC) disposition, adverse events, and length of stay(LOS) between MIS and open surgery were compared and stratified by age. Adjustment was made for selected confounders using inverse probability weighting.
Of 6913 emergent CRS cases across 50 hospitals, 1616(23%) were approached MIS. MIS cases were more likely [OR(95%CI)] to DC home [<65yo:1.7(1.3,2.2); 65–74:1.5(1.1,1.9); 75+:1.2(0.9,1.5)] and have fewer adverse events [<65yo:0.6(0.5,0.8); 65–74:0.7(0.5,0.9); 75+:0.7(0.5,0.9)]. LOS was shorter [Mean difference in days(95%CI)] [<65yo: 2.2(-2.9,-1.4); 65–74: 0.9(-2.7,1.0); 75+: 0.7(-1.7,0.2)].
MIS in emergent CRS is associated with increased DC to home, fewer adverse events, and shorter LOS. Benefits persisted with age after adjustment, suggesting an opportunity for improved MIS delivery in older adults.
•Less than ¼ of emergent colorectal cases are approached minimally invasively.•MIS use in emergency CRS was incrementally lower in older adults, no matter the time of day.•MIS was associated with improved outcomes in all patients, including older adults.</description><subject>Abdomen</subject><subject>Adults</subject><subject>Adverse events</subject><subject>Age</subject><subject>Age groups</subject><subject>Aging</subject><subject>Cancer</subject><subject>Colorectal</subject><subject>Colorectal surgery</subject><subject>Elderly</subject><subject>Emergency surgery</subject><subject>Fistula</subject><subject>Health services</subject><subject>Hospitals</subject><subject>Hypotheses</subject><subject>Inflammatory bowel disease</subject><subject>Laparoscopy</subject><subject>Length of stay</subject><subject>Minimally invasive surgery</subject><subject>Older people</subject><subject>Patients</subject><subject>Surgery</subject><subject>Variables</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkdGK1DAUhoO4uOPqIygBb_am3aRJ09YbGQZ1F1ZWUK9Dmpx2U5pmTNqBeYJ9bVNm9MKbhZAQ-P5zkvMh9I6SnBIqboZcuSEuoc8LUhQ5YTkpyxdoQ-uqyWhds5doQwgpskZQcolexzikK6WcvUKXrOSsoiXfoKdvdrJOjeMxs9NBRXsArPb74JV-xLPH4CD0MM1Y-9EH0LMa8doVwhHbCaveTj1WZhnn-BFvcYC9DzPugnd4fgT8I6FWp8xOBcAPy6y9g4i3MUKMbq37Pfg-KPcGXXRqjPD2fF6hX18-_9zdZvcPX-922_tMM07ntHesM13FtNJtUTNtVNUBFcA1bwvRlW2rta4F55VqKDfCdIYYVlPWCCCtYlfo-lQ3ffH3AnGWzkYN46gm8EuUhSiLsmacNQn98B86-CVM6XWJakiTFhOJKk-UDj7GAJ3chzTQcJSUyNWUHOTZlFxNScJkMpVy78_Vl9aB-Zf6qyYBn04ApHEcLAQZtYVJg7GrB2m8fabFH8YBqqA</recordid><startdate>20220801</startdate><enddate>20220801</enddate><creator>Charboneau, Alex</creator><creator>Feldmann, Timothy</creator><creator>Kanneganti, Shalini</creator><creator>Kaplan, Jennifer A.</creator><creator>Moonka, Ravi</creator><creator>Sillah, Arthur</creator><creator>Thirlby, Richard C.</creator><creator>Simianu, Vlad V.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9146-5174</orcidid></search><sort><creationdate>20220801</creationdate><title>Minimally-invasive approach to emergent colorectal surgery in aging adults: A report from the Surgical Care Outcomes Assessment Program</title><author>Charboneau, Alex ; Feldmann, Timothy ; Kanneganti, Shalini ; Kaplan, Jennifer A. ; Moonka, Ravi ; Sillah, Arthur ; Thirlby, Richard C. ; Simianu, Vlad V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c341t-c3f3fdf73cacb283cda7fe16e4c4b26f5bbccc86447a914d6dfd0d381396e0ba3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Abdomen</topic><topic>Adults</topic><topic>Adverse events</topic><topic>Age</topic><topic>Age groups</topic><topic>Aging</topic><topic>Cancer</topic><topic>Colorectal</topic><topic>Colorectal surgery</topic><topic>Elderly</topic><topic>Emergency surgery</topic><topic>Fistula</topic><topic>Health services</topic><topic>Hospitals</topic><topic>Hypotheses</topic><topic>Inflammatory bowel disease</topic><topic>Laparoscopy</topic><topic>Length of stay</topic><topic>Minimally invasive surgery</topic><topic>Older people</topic><topic>Patients</topic><topic>Surgery</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Charboneau, Alex</creatorcontrib><creatorcontrib>Feldmann, Timothy</creatorcontrib><creatorcontrib>Kanneganti, Shalini</creatorcontrib><creatorcontrib>Kaplan, Jennifer A.</creatorcontrib><creatorcontrib>Moonka, Ravi</creatorcontrib><creatorcontrib>Sillah, Arthur</creatorcontrib><creatorcontrib>Thirlby, Richard C.</creatorcontrib><creatorcontrib>Simianu, Vlad V.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Charboneau, Alex</au><au>Feldmann, Timothy</au><au>Kanneganti, Shalini</au><au>Kaplan, Jennifer A.</au><au>Moonka, Ravi</au><au>Sillah, Arthur</au><au>Thirlby, Richard C.</au><au>Simianu, Vlad V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Minimally-invasive approach to emergent colorectal surgery in aging adults: A report from the Surgical Care Outcomes Assessment Program</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2022-08-01</date><risdate>2022</risdate><volume>224</volume><issue>2</issue><spage>751</spage><epage>756</epage><pages>751-756</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><abstract>Despite known benefits of minimally invasive surgery(MIS) in elective settings, MIS use in emergency colorectal surgery(CRS) is limited. Older adults are more likely to require emergent CRS, and MIS is used less frequently with increasing age.
A retrospective cohort was constructed of emergent CRS cases performed between 2011 and 2019. Discharge(DC) disposition, adverse events, and length of stay(LOS) between MIS and open surgery were compared and stratified by age. Adjustment was made for selected confounders using inverse probability weighting.
Of 6913 emergent CRS cases across 50 hospitals, 1616(23%) were approached MIS. MIS cases were more likely [OR(95%CI)] to DC home [<65yo:1.7(1.3,2.2); 65–74:1.5(1.1,1.9); 75+:1.2(0.9,1.5)] and have fewer adverse events [<65yo:0.6(0.5,0.8); 65–74:0.7(0.5,0.9); 75+:0.7(0.5,0.9)]. LOS was shorter [Mean difference in days(95%CI)] [<65yo: 2.2(-2.9,-1.4); 65–74: 0.9(-2.7,1.0); 75+: 0.7(-1.7,0.2)].
MIS in emergent CRS is associated with increased DC to home, fewer adverse events, and shorter LOS. Benefits persisted with age after adjustment, suggesting an opportunity for improved MIS delivery in older adults.
•Less than ¼ of emergent colorectal cases are approached minimally invasively.•MIS use in emergency CRS was incrementally lower in older adults, no matter the time of day.•MIS was associated with improved outcomes in all patients, including older adults.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>35437154</pmid><doi>10.1016/j.amjsurg.2022.03.055</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-9146-5174</orcidid></addata></record> |
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| subjects | Abdomen Adults Adverse events Age Age groups Aging Cancer Colorectal Colorectal surgery Elderly Emergency surgery Fistula Health services Hospitals Hypotheses Inflammatory bowel disease Laparoscopy Length of stay Minimally invasive surgery Older people Patients Surgery Variables |
| title | Minimally-invasive approach to emergent colorectal surgery in aging adults: A report from the Surgical Care Outcomes Assessment Program |
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