Predictive Risk Factors for Intra‐ and Postoperative Complications in 526 Laparoscopic Sigmoid Resections due to Recurrent Diverticulitis: A Multivariate Analysis

Abstract

Background Laparoscopic sigmoid resection is a feasible and frequent operation for patients who suffer from recurrent diverticulitis. There is still an ongoing debate about the optimal timing for surgery in patients who suffer from recurrent diverticulitis episodes. In elective situations the complication rate for this procedure is moderate, but there are patients at high risk for perioperative complications. The few identified risk factors so far refer to open surgery. Data for the elective laparoscopic approach is rare. The objective of this study was to identify potential predictive risk factors for intra-and postoperative complications in patients who underwent laparoscopic sigmoid resection due to diverticular disease. Methods Uni-and multivariate analyses of a prospectively gathered database (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006) were performed on a consecutive series of 526 patients who underwent laparoscopic sigmoid resection due to recurrent diverticulitis in a single institution. Patients were assessed for demographic data, operative indications, and intra-and postoperative complications. Altogether, we analyzed 17 potential risk factors to identify significant influence on the intra-and postoperative outcome, including timing of surgery. Results Statistical analysis of specific medical and surgical complications revealed anemia, previous myocardial infarction, heart failure, experience of the surgeon, and male gender, as independent predictive risk factors for postoperative complications. Patients older than age 75 years was the only independent risk factor for intraoperative complications in a multiple logistic regression model. Early elective surgery led to increased conversion rate but did not influence the postoperative complication rate. Conclusions This large, single-center study provides first evidence of the significance of specific predictive risk factors for intra-and postoperative complications in laparoscopic sigmoid resection for diverticular disease.

Intraoperative adverse events during laparoscopic colorectal resection—better laparoscopic treatment but unchanged incidence. Lessons learnt from a Swiss multi-institutional analysis of 3,928 patients

“…Overall, intraoperative adverse events did not change over time even after we corrected for age, gender, BMI, and malignant disease, the most commonly identified factors associated with an intraoperative adverse event [13,[24][25][26]. However, an intraoperative adverse event significantly increased postoperative morbidity from 17 to 33 % in our study.…”

Inpatient versus outpatient onsets of acute myocardial infarction

“…For instance, from the patients who underwent laparoscopic sigmoid resection for diverticular disease, 1.14% had cardiac complications [16], while 11.2% patients suffered an AMI after colorectal surgery [17]. Patients undergoing head and neck surgery had an AMI rate of 0.3% [18].…”

Surgical outcomes and their relation to the number of prior episodes of diverticulitis

“…In a large study with 526 patients who underwent laparoscopic sigmoid resection for recurrent diverticulitis, male gender, anemia, previous myocardial infarction, heart failure and level of surgeons’ experience were independent predictive risk factors for postoperative complications such as anastomotic leakage, SSI and bleeding [25]. The same study reported age (≥75 years) as the only independent risk factor for intra-operative complications like bowel and ureteric injury and bleeding; however, these authors did not report on pre-operative abscess or fistula.…”