Conference Coverage

Laparoscopic procedure safer for SBO in elderly patients

Publish date: February 14, 2018
By
Richard Mark Kirkner

 

REPORTING FROM THE ACADEMIC SURGICAL CONGRESS

JACKSONVILLE, FLA. – Octogenarians with small-bowel obstruction are about seven times more likely to have open than laparoscopic surgery, but the minimally invasive approach in these patients has been found to reduce their hospital stays and risk of pneumonia afterward, according to results of an observational study of data from the American College of Surgeons National Surgical Quality Improvement Program database.

Surgeons work on a patient in the operating room Dmitrii Kotin/Thinkstock
“The octogenarian population is expected to increase, and general surgeons will need to provide surgical options to the elderly,” Erin Chang, MD, of the State University of New York Downstate Medical Center, Brooklyn, said in reporting the results at the Association for Academic Surgery/Society of University Surgeons Academic Surgical Congress. “At this time there is literature supporting laparoscopic surgery for cholecystectomy and colectomies in the octogenarian population, which is associated with decreased length of stay and pain, but the open approach is often employed for small bowel obstruction.”

Dr. Chang said, “Our study was able to show that age and the presence of preoperative sepsis are associated with mortality rather than procedure type, and that there are procedure-type risks associated with open procedures.”

The observational study analyzed 103 laparoscopic and 692 open operations for small-bowel obstruction (SBO) in patients 80 and older from 2006 to 2014. Characteristics of the open and laparoscopic group – age, gender, body mass index, and race – were similar, although the open group had higher American Society of Anesthesiologists classification and incidence of preoperative sepsis, Dr. Chang said.

“Unadjusted outcomes showed longer length of stay [and] higher postoperative mortality and rates of postoperative pneumonia in the open cases vs. laparoscopic,” she said. “But after we made adjustments for preoperative risk variables, age and the presence of preoperative sepsis were associated with mortality, not the operative approach.” Length of stay was 4 days for the laparoscopic patients vs. 8 days for open (P less than .0001).

The researchers performed logistical regression analysis and found that mortality risk rose slightly with age (odds ratio, 1.11; P = .0311) but almost quadrupled with preoperative sepsis (OR, 3.77; P = .0287) regardless of open or laparoscopic approach. For postoperative pneumonia, risk factors were male gender (OR, 2.68; P = .0003) and open procedure (OR, 5.03; P = .0282).

“Our study elucidates that the octogenarian with small-bowel obstruction due to adhesive disease may benefit from an initial laparoscopic approach,” Dr. Change said. “Further prospective studies are warranted.”

Dr. Chang and coauthors reported having no financial disclosures.

SOURCE: Chang E et al. Academic Surgical Congress.

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