M. Khan1, J. Meier1, M. Nehrubabu1, P. Polanco1 1University Of Texas Southwestern Medical Center, Department Of Surgery, Dallas, TX, USA
Introduction:
Frail patients are at high risk of death and complications following emergency colon surgeries. While most factors are not modifiable, surgical technique is one modifiable factor which could be addressed in an emergency setting. While minimally invasive surgery is shown to improve outcomes in the general patient population, the effect of minimally invasive surgery on frail patients undergoing emergency surgery is not known.
Methods:
We identified frail patients who underwent urgent or emergent colon resections from 2017 to 2021 from the National Surgical Quality Improvement Program database based on CPT codes. We defined frail patients as those with score of ≥2 using the modified frailty index. Our exposure of interest was surgical technique and included open surgery (OS) and minimally invasive surgery (MIS). To determine the association of surgical technique with outcomes independent of other covariates and diagnoses, inverse probability of treatment weighted (IPTW) analysis was performed with the intent to reduce the standardized difference to at least less than 10%.
Results:
In total, 11,976 patients, with a mean age was 71.0 years (SD 11.5), were included. Of these 10,293 (87.2%) underwent open surgery and 1,503 (12.7%) underwent minimally invasive surgery. Both groups were similar in their age and gender distribution. A significantly greater proportion of patients in the OS group had more comorbid conditions. Most common diagnosis in the OS group was intra-abdominal sepsis (59.6%) while in the MIS group it was neoplasms (42%). After performing the IPTW analysis, the standardized difference between the covariates was reduced to 1.7% or less. MIS was independently associated with a reduction in the odds of death by 4.6% (OR 0.95, 95% CI 0.93-0.97; p-value <0.001), severe complications by 6.9% (OR 0.93, 95% CI 0.90 – 0.95, p-value <0.001), any complication by 8.8% (OR 0.91, 95% CI 0.88-0.94, p-value <0.001), septic shock by 5.9% (OR 0.94, 95% CI 0.92 – 0.96 p-value <0.001), post operative bleeding requiring blood transfusion by 4% (OR 0.95 95% CI 0.93 – 0.98 p-value <0.001), prolonged hospital stay (>14days) by 4.2% (OR 0.95, 95% CI 0.92 – 0.99 p-value 0.02) and other post operative complications.
Conclusion:
In this highly vulnerable population of frail patients, minimally invasive surgery was associated with reduced odds of morbidity and mortality. Given these real-world data findings, MIS approach should be considered in emergency colon surgeries provided proficient surgical expertise and equipment are available.
