K. Tabibian1, E. Aguayo1,2, N. Cho1, D. Yalzadeh1, N. Le1, O. Kwon1,2, A. Chaturvedi1, H. Lee2, P. Benharash1,3 1Center For Advanced Surgical & Interventional Technology (CASIT), David Geffen School Of Medicine, University Of California At Los Angeles, Los Angeles, CA, USA 2Department Of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA 3Department Of Surgery, David Geffen School Of Medicine, University Of California At Los Angeles, Los Angeles, CA, USA
Introduction: The choice of laparoscopic or open colostomy reversal remains controversial with limited available evidence. This study aims to evaluate the clinical outcomes associated with these colostomy reversal techniques in a national cohort of patients.
Methods: The 2015-2020 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) participant use file data was queried to identify all adult (≥18 years) patients who underwent elective open (OCT) or laparoscopic colostomy takedown (LCT). Patients with missing data (age, American Society of Anesthesiologists (ASA) class, Body Mass Index (BMI), functional status, or elective surgery status) were excluded. The primary outcomes were the 30-day complication rates (cardiac, respiratory, thromboembolic, renal, infectious, wound dehiscence, and transfusion). Secondary outcomes included post-operative length of stay (LOS), non-home discharge, operative duration, 30-day readmissions, and unplanned return to the operating room. Multivariable regression models were developed to assess the associations of operative modalities with outcomes of interest.
Results: Of an estimated 16,068 patients undergoing colostomy takedown during the study period, 11,303 (70.3%) underwent OCT. Compared to patients undergoing the open approach, those managed laparoscopically had lower rates of comorbid conditions, including COPD (4.1% vs 5.6%, p<0.001) and hypertension (45.7% vs 48.5%, p<0.001). In our unadjusted analysis, LCT was associated with a shorter length of stay (4 [3-5] vs 5 [4-7] days, p<0.001), lower rates of non-home discharge (3.4% vs 5.5%, p<0.001), and shorter operative duration (172 [119-240] vs 188 [131-263] minutes, p<0.001).
After multivariable adjustment, patients who underwent laparoscopic colostomy reversal were independently associated with lower odds of 30-day readmission (Adjusted Odds Ratio [AOR] 0.83, 95% Confidence Interval [95%CI] 0.73-0.95, p=0.006). Additionally, LCT was associated with lower odds of perioperative respiratory (AOR 0.49, 95% CI 0.33-0.73, p<0.001), infectious (AOR 0.55, 95% CI 0.49-0.63, p<0.001), and wound dehiscence complications (AOR 0.39, 95% CI 0.25-0.61, p<0.001), as well as unplanned return to the operating room (AOR 0.77, 95% CI 0.61-0.96, p=0.02) (Figure).
Conclusion: From 2015 to 2020, laparoscopic colostomy takedown was associated with lower 30-day readmission rates and complications compared to open surgery. These findings suggest that LCT may be a safe surgery for these patients and warrants further investigation.