Advantages of laparoscopic colectomy in older patients

Anthony J. Senagore, Khaled M. Madbouly, Victor W. Fazio, Hans J. Duepree, Karen M. Brady, Conor P. Delaney

Research output: Contribution to journalArticle

114 Citations (Scopus)

Abstract

Hypothesis: Few data describe the relative benefits of an expedited recovery program and laparoscopic technique in older vs younger patients undergoing colectomy. We compared short-term outcomes in age-matched cohorts of patients undergoing laparoscopic vs open segmental colectomy managed with the Controlled Rehabilitation With Early Ambulation and Diet program. Design: Four age-matched cohorts of patients were compared: (1) patients 70 years or older undergoing laparoscopic colectomy (group 1), (2) those 70 or older undergoing open colectomy (group 2), (3) those younger than 60 undergoing laparoscopic colectomy (group 3), and (4) those younger than 60 undergoing open colectomy (group 4). Methods: Data collected included age, sex, body mass index, Physiologic and Operative Severity Score for the Enumeration of Morbidity and Mortality, American Society of Anesthesiologists' score, estimated blood loss, operative duration in minutes, pathologic findings, type of segmental colectomy, complications, mortality, length of hospital stay, and 30-day readmission rate. Results: Four hundred seventy-six patients fulfilled the inclusion criteria and had complete data available for collection (group 1, 50 patients; group 2, 123 patients; group 3,181 patients; and group 4, 122 patients). Demographic data, operative procedures, and pathologic findings were similar among the cohorts. The mean±SEM length of hospital stay was significantly shorter with laparoscopic surgery in both age cohorts (group 1, 4.2±3. 0 days; group 2, 9.3±7.6 days; group 3, 3.9±5.9 days; and group 4, 6.1±3.0 days). The mean±SEM direct hospital costs were significantly lower only with laparoscopic colectomy in the older cohorts. Using the Physiologic and Operative Severity Score for the Enumeration of Morbidity and Mortality, it was noted that group 2 experienced an observed rate of morbidity similar to that predicted. Conversely, groups 1, 3, and 4 had rates that were significantly lower than expected. Mean±SEM readmission rates were comparable in the older cohorts (group 1, 6.0%, and group 2, 6.5%) but significantly different in the younger cohorts (group 3, 9.4%, and group 4, 4.1%). Conclusions: The Controlled Rehabilitation With Early Ambulation and Diet program in combination with laparoscopic segmental colectomy can be safely performed in all age groups. The technique offers particular advantages to older patients because of reductions in length of hospital stay, morbidity and mortality rates, and direct cost of care.

Original languageEnglish (US)
Pages (from-to)252-256
Number of pages5
JournalArchives of Surgery
Volume138
Issue number3
DOIs
StatePublished - Mar 1 2003
Externally publishedYes

Fingerprint

Colectomy
Length of Stay
Morbidity
Early Ambulation
Mortality
Rehabilitation
Age Groups
Diet
Hospital Costs
Operative Surgical Procedures
Hospital Mortality
Laparoscopy
Body Mass Index
Demography
Costs and Cost Analysis

ASJC Scopus subject areas

  • Surgery

Cite this

Senagore, A. J., Madbouly, K. M., Fazio, V. W., Duepree, H. J., Brady, K. M., & Delaney, C. P. (2003). Advantages of laparoscopic colectomy in older patients. Archives of Surgery, 138(3), 252-256. https://doi.org/10.1001/archsurg.138.3.252

Advantages of laparoscopic colectomy in older patients. / Senagore, Anthony J.; Madbouly, Khaled M.; Fazio, Victor W.; Duepree, Hans J.; Brady, Karen M.; Delaney, Conor P.

In: Archives of Surgery, Vol. 138, No. 3, 01.03.2003, p. 252-256.

Research output: Contribution to journalArticle

Senagore, AJ, Madbouly, KM, Fazio, VW, Duepree, HJ, Brady, KM & Delaney, CP 2003, 'Advantages of laparoscopic colectomy in older patients', Archives of Surgery, vol. 138, no. 3, pp. 252-256. https://doi.org/10.1001/archsurg.138.3.252
Senagore AJ, Madbouly KM, Fazio VW, Duepree HJ, Brady KM, Delaney CP. Advantages of laparoscopic colectomy in older patients. Archives of Surgery. 2003 Mar 1;138(3):252-256. https://doi.org/10.1001/archsurg.138.3.252
Senagore, Anthony J. ; Madbouly, Khaled M. ; Fazio, Victor W. ; Duepree, Hans J. ; Brady, Karen M. ; Delaney, Conor P. / Advantages of laparoscopic colectomy in older patients. In: Archives of Surgery. 2003 ; Vol. 138, No. 3. pp. 252-256.
@article{b15ef09a4ae944f39a9778404b8688e5,
title = "Advantages of laparoscopic colectomy in older patients",
abstract = "Hypothesis: Few data describe the relative benefits of an expedited recovery program and laparoscopic technique in older vs younger patients undergoing colectomy. We compared short-term outcomes in age-matched cohorts of patients undergoing laparoscopic vs open segmental colectomy managed with the Controlled Rehabilitation With Early Ambulation and Diet program. Design: Four age-matched cohorts of patients were compared: (1) patients 70 years or older undergoing laparoscopic colectomy (group 1), (2) those 70 or older undergoing open colectomy (group 2), (3) those younger than 60 undergoing laparoscopic colectomy (group 3), and (4) those younger than 60 undergoing open colectomy (group 4). Methods: Data collected included age, sex, body mass index, Physiologic and Operative Severity Score for the Enumeration of Morbidity and Mortality, American Society of Anesthesiologists' score, estimated blood loss, operative duration in minutes, pathologic findings, type of segmental colectomy, complications, mortality, length of hospital stay, and 30-day readmission rate. Results: Four hundred seventy-six patients fulfilled the inclusion criteria and had complete data available for collection (group 1, 50 patients; group 2, 123 patients; group 3,181 patients; and group 4, 122 patients). Demographic data, operative procedures, and pathologic findings were similar among the cohorts. The mean±SEM length of hospital stay was significantly shorter with laparoscopic surgery in both age cohorts (group 1, 4.2±3. 0 days; group 2, 9.3±7.6 days; group 3, 3.9±5.9 days; and group 4, 6.1±3.0 days). The mean±SEM direct hospital costs were significantly lower only with laparoscopic colectomy in the older cohorts. Using the Physiologic and Operative Severity Score for the Enumeration of Morbidity and Mortality, it was noted that group 2 experienced an observed rate of morbidity similar to that predicted. Conversely, groups 1, 3, and 4 had rates that were significantly lower than expected. Mean±SEM readmission rates were comparable in the older cohorts (group 1, 6.0{\%}, and group 2, 6.5{\%}) but significantly different in the younger cohorts (group 3, 9.4{\%}, and group 4, 4.1{\%}). Conclusions: The Controlled Rehabilitation With Early Ambulation and Diet program in combination with laparoscopic segmental colectomy can be safely performed in all age groups. The technique offers particular advantages to older patients because of reductions in length of hospital stay, morbidity and mortality rates, and direct cost of care.",
author = "Senagore, {Anthony J.} and Madbouly, {Khaled M.} and Fazio, {Victor W.} and Duepree, {Hans J.} and Brady, {Karen M.} and Delaney, {Conor P.}",
year = "2003",
month = "3",
day = "1",
doi = "10.1001/archsurg.138.3.252",
language = "English (US)",
volume = "138",
pages = "252--256",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "3",

}

TY - JOUR

T1 - Advantages of laparoscopic colectomy in older patients

AU - Senagore, Anthony J.

AU - Madbouly, Khaled M.

AU - Fazio, Victor W.

AU - Duepree, Hans J.

AU - Brady, Karen M.

AU - Delaney, Conor P.

PY - 2003/3/1

Y1 - 2003/3/1

N2 - Hypothesis: Few data describe the relative benefits of an expedited recovery program and laparoscopic technique in older vs younger patients undergoing colectomy. We compared short-term outcomes in age-matched cohorts of patients undergoing laparoscopic vs open segmental colectomy managed with the Controlled Rehabilitation With Early Ambulation and Diet program. Design: Four age-matched cohorts of patients were compared: (1) patients 70 years or older undergoing laparoscopic colectomy (group 1), (2) those 70 or older undergoing open colectomy (group 2), (3) those younger than 60 undergoing laparoscopic colectomy (group 3), and (4) those younger than 60 undergoing open colectomy (group 4). Methods: Data collected included age, sex, body mass index, Physiologic and Operative Severity Score for the Enumeration of Morbidity and Mortality, American Society of Anesthesiologists' score, estimated blood loss, operative duration in minutes, pathologic findings, type of segmental colectomy, complications, mortality, length of hospital stay, and 30-day readmission rate. Results: Four hundred seventy-six patients fulfilled the inclusion criteria and had complete data available for collection (group 1, 50 patients; group 2, 123 patients; group 3,181 patients; and group 4, 122 patients). Demographic data, operative procedures, and pathologic findings were similar among the cohorts. The mean±SEM length of hospital stay was significantly shorter with laparoscopic surgery in both age cohorts (group 1, 4.2±3. 0 days; group 2, 9.3±7.6 days; group 3, 3.9±5.9 days; and group 4, 6.1±3.0 days). The mean±SEM direct hospital costs were significantly lower only with laparoscopic colectomy in the older cohorts. Using the Physiologic and Operative Severity Score for the Enumeration of Morbidity and Mortality, it was noted that group 2 experienced an observed rate of morbidity similar to that predicted. Conversely, groups 1, 3, and 4 had rates that were significantly lower than expected. Mean±SEM readmission rates were comparable in the older cohorts (group 1, 6.0%, and group 2, 6.5%) but significantly different in the younger cohorts (group 3, 9.4%, and group 4, 4.1%). Conclusions: The Controlled Rehabilitation With Early Ambulation and Diet program in combination with laparoscopic segmental colectomy can be safely performed in all age groups. The technique offers particular advantages to older patients because of reductions in length of hospital stay, morbidity and mortality rates, and direct cost of care.

AB - Hypothesis: Few data describe the relative benefits of an expedited recovery program and laparoscopic technique in older vs younger patients undergoing colectomy. We compared short-term outcomes in age-matched cohorts of patients undergoing laparoscopic vs open segmental colectomy managed with the Controlled Rehabilitation With Early Ambulation and Diet program. Design: Four age-matched cohorts of patients were compared: (1) patients 70 years or older undergoing laparoscopic colectomy (group 1), (2) those 70 or older undergoing open colectomy (group 2), (3) those younger than 60 undergoing laparoscopic colectomy (group 3), and (4) those younger than 60 undergoing open colectomy (group 4). Methods: Data collected included age, sex, body mass index, Physiologic and Operative Severity Score for the Enumeration of Morbidity and Mortality, American Society of Anesthesiologists' score, estimated blood loss, operative duration in minutes, pathologic findings, type of segmental colectomy, complications, mortality, length of hospital stay, and 30-day readmission rate. Results: Four hundred seventy-six patients fulfilled the inclusion criteria and had complete data available for collection (group 1, 50 patients; group 2, 123 patients; group 3,181 patients; and group 4, 122 patients). Demographic data, operative procedures, and pathologic findings were similar among the cohorts. The mean±SEM length of hospital stay was significantly shorter with laparoscopic surgery in both age cohorts (group 1, 4.2±3. 0 days; group 2, 9.3±7.6 days; group 3, 3.9±5.9 days; and group 4, 6.1±3.0 days). The mean±SEM direct hospital costs were significantly lower only with laparoscopic colectomy in the older cohorts. Using the Physiologic and Operative Severity Score for the Enumeration of Morbidity and Mortality, it was noted that group 2 experienced an observed rate of morbidity similar to that predicted. Conversely, groups 1, 3, and 4 had rates that were significantly lower than expected. Mean±SEM readmission rates were comparable in the older cohorts (group 1, 6.0%, and group 2, 6.5%) but significantly different in the younger cohorts (group 3, 9.4%, and group 4, 4.1%). Conclusions: The Controlled Rehabilitation With Early Ambulation and Diet program in combination with laparoscopic segmental colectomy can be safely performed in all age groups. The technique offers particular advantages to older patients because of reductions in length of hospital stay, morbidity and mortality rates, and direct cost of care.

UR - http://www.scopus.com/inward/record.url?scp=0037334694&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037334694&partnerID=8YFLogxK

U2 - 10.1001/archsurg.138.3.252

DO - 10.1001/archsurg.138.3.252

M3 - Article

VL - 138

SP - 252

EP - 256

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

IS - 3

ER -