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Laparoscopy is associated with decreased all-cause mortality in patients undergoing emergency general surgery procedures in a regional health system

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Abstract

Background

The aim of this study was to evaluate the use of laparoscopic surgery for common emergency general surgery (EGS) procedures within an integrated Acute Care Surgery (ACS) network. We hypothesized that laparoscopy would be associated with improved outcomes.

Methods

Our integrated health care system’s EGS registry created from AAST EGS ICD-9 codes was queried from January 2013 to October 2015. Procedures were grouped as laparoscopic or open. Standard descriptive and univariate tests were performed, and a multivariable logistic regression controlling for open status, age, BMI, Charlson Comorbidity Index (CCI), trauma tier, and resuscitation diagnosis was performed. Laparoscopic procedures converted to open were identified and analyzed using concurrent procedure billing codes across episodes of care.

Results

Of 60,604 EGS patients identified over the 33-month period, 7280 (12.0%) had an operation and 6914 (11.4%) included AAST-defined EGS procedures. There were 4813 (69.6%) surgeries performed laparoscopically. Patients undergoing a laparoscopic procedure tended to be younger (45.7 ± 18.0 years vs. 57.2 ± 17.6, p < 0.001) with similar BMI (29.7 ± 9.0 kg/m2 vs. 28.8 ± 8.3, p < 0.001). Patients in the laparoscopic group had lower mean CCI score (1.6 ± 2.3 vs. 3.4 ± 3.2, p ≤ 0.0001). On multivariable analysis, open surgery had the highest association with inpatient mortality (OR 8.67, 4.23–17.75, p < 0.0001) and at all time points (30-, 90-day, 1-, 3-year). At all time points, conversion to open was found to be a statistically significant protective factor.

Conclusion

Use of laparoscopy in EGS is common and associated with a decreased risk of all-cause mortality at all time points compared to open procedures. Conversion to open was protective at all time points compared to open procedures.

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Acknowledgements

Jill Jurgensen for medical editing and proofing.

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This research received no specific grant from a funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA

    Caroline E. Reinke, Susan L. Evans, Mary M. Jordan, Yancey E. Warren, Addison K. May, Brent D. Matthews & Samuel W. Ross

  2. School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Sean J. Donohue

  3. Carolinas Medical Center, Center for Outcomes Research and Evaluation, Charlotte, NC, USA

    Timothy Hetherington & Marc Kowalkowski

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  1. Sean J. Donohue
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  2. Caroline E. Reinke
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Sean J. Donohue, Caroline E. Reinke, Susan L. Evans, Mary M. Jordan, Yancey E. Warren, Timothy Hetherington, Marc Kowalkowski, Addison K. May, Brent D. Matthews, and Samuel W. Ross have no conflicts of interest or financial ties to disclose.

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Donohue, S.J., Reinke, C.E., Evans, S.L. et al. Laparoscopy is associated with decreased all-cause mortality in patients undergoing emergency general surgery procedures in a regional health system. Surg Endosc 36, 3822–3832 (2022). https://doi.org/10.1007/s00464-021-08699-1

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