TY - JOUR
T1 - Colectomy for patients with super obesity
T2 - current practice and surgical morbidity in the United States
AU - Abd El Aziz, Mohamed A.
AU - Grass, Fabian
AU - Perry, William
AU - Behm, Kevin T.
AU - Shawki, Sherief F.
AU - Larson, David W.
AU - Mathis, Kellie L.
N1 - Publisher Copyright:
© 2020 American Society for Bariatric Surgery
PY - 2020/11
Y1 - 2020/11
N2 - Background: While minimally invasive surgery contributed to improved outcomes in bariatric surgery, less is known about current utilization trends and outcomes related to surgical technique for colorectal resections in super-obese patients (body mass index ≥50 kg/m2). Objective: The aim of this study was to compare surgical modalities and short-term outcomes of patients with super obesity who underwent elective colectomy in the United States. Setting: A retrospective review was performed of patients with super obesity who underwent elective colectomy between 2012 to 2018 using the American College of Surgeons National Quality Improvement Program data pool. Methods: Patients were categorized into an open, laparoscopic, or robotic group. Baseline characteristics and perioperative outcomes including 30-day complications and length of stay were compared between the 3 groups. Furthermore, utilization trends of surgical modalities were assessed. Results: Of 1199 patients, 338 (28.2%) had open, 735 (61.3%) laparoscopic, and 126 (10.5%) robotic colectomy during the study period, primarily for colon cancer (50.8%). Patients in the open group tended to have more baseline co-morbidities. Laparoscopic approach showed better risk-adjusted outcomes compared with open for postoperative ileus (adjusted odds ratio [aOR]: .6, 95% confidence interval [CI; .383–.965]), overall medical complications (aOR: .4, 95%CI [.3–.8]), and length of stay (OR .6, 95% CI [.394–.968]). Trend utilization showed increasing utilization of the robotic platform over the study period, which was associated with less unplanned conversion to open (aOR .417, 95%CI [.199–.872]). Conclusion: Laparoscopic colectomy provides advantageous outcomes over open surgery for colectomy in super-obese patients. The robotic platform has been increasingly used over time, and potential benefits need to be further studied.
AB - Background: While minimally invasive surgery contributed to improved outcomes in bariatric surgery, less is known about current utilization trends and outcomes related to surgical technique for colorectal resections in super-obese patients (body mass index ≥50 kg/m2). Objective: The aim of this study was to compare surgical modalities and short-term outcomes of patients with super obesity who underwent elective colectomy in the United States. Setting: A retrospective review was performed of patients with super obesity who underwent elective colectomy between 2012 to 2018 using the American College of Surgeons National Quality Improvement Program data pool. Methods: Patients were categorized into an open, laparoscopic, or robotic group. Baseline characteristics and perioperative outcomes including 30-day complications and length of stay were compared between the 3 groups. Furthermore, utilization trends of surgical modalities were assessed. Results: Of 1199 patients, 338 (28.2%) had open, 735 (61.3%) laparoscopic, and 126 (10.5%) robotic colectomy during the study period, primarily for colon cancer (50.8%). Patients in the open group tended to have more baseline co-morbidities. Laparoscopic approach showed better risk-adjusted outcomes compared with open for postoperative ileus (adjusted odds ratio [aOR]: .6, 95% confidence interval [CI; .383–.965]), overall medical complications (aOR: .4, 95%CI [.3–.8]), and length of stay (OR .6, 95% CI [.394–.968]). Trend utilization showed increasing utilization of the robotic platform over the study period, which was associated with less unplanned conversion to open (aOR .417, 95%CI [.199–.872]). Conclusion: Laparoscopic colectomy provides advantageous outcomes over open surgery for colectomy in super-obese patients. The robotic platform has been increasingly used over time, and potential benefits need to be further studied.
KW - Colectomy
KW - Colorectal surgery
KW - Laparoscopic
KW - Minimally invasive
KW - Obesity
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U2 - 10.1016/j.soard.2020.06.033
DO - 10.1016/j.soard.2020.06.033
M3 - Article
C2 - 32798126
AN - SCOPUS:85089289038
SN - 1550-7289
VL - 16
SP - 1764
EP - 1769
JO - Surgery for Obesity and Related Diseases
JF - Surgery for Obesity and Related Diseases
IS - 11
ER -