Respiratory complications after colonic procedures in chronic obstructive pulmonary disease: does laparoscopy offer a benefit?

Sujatha-Bhaskar, Sarath; Alizadeh, Reza; Inaba, Colette S.; Koh, Christina Y.; Jafari, Mehraneh D.; Mills, Steven; Carmichael, Joseph C.; Stamos, Michael J.; Pigazzi, Alessio

doi:10.1007/s00464-017-5805-5

Cited by 18 publications

(24 citation statements)

References 15 publications

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“…Other studies have demonstrated the decrease in pulmonary complications by using minimally invasive techniques. 13 The study by Juo et al showed similar results with the addition of separating out LC and RAC from OC. 12 Furthermore, while the RAC had higher costs, it had the lowest postoperative complications.…”

Section: Discussionmentioning

confidence: 74%

Utilization of Laparoscopic Colon Surgery in the Texas Inpatient Public Use Data File (PUDF)

Clapp¹,

Klingsporn²,

Harper³

et al. 2019

JSLS

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Background: Laparoscopic surgery has become the standard of care for the most common surgical procedures performed. However, laparoscopic techniques have not reached this same penetrance in colorectal surgery. We wanted to determine the percentage of colon operations performed in Texas that were done via laparoscopic, robotic and open techniques. Methods: The Texas Inpatient Public Use Data File (PUDF) was queried using ICD-9-CM diagnostic and procedure codes to determine overall utilization of laparoscopic colectomies (LC) in Texas between 2013-14 for reporting facilities. We specifically looked at cost and the length of stay for LC, open colectomy (OC) and robotic assisted colectomy (RAC). Results: In the state of Texas between 2013-14 there were 20,454 colectomies performed. Of these 12,328 (60.3%) were OC, 7,536 (36.8%) were LC, and 590 (3.9%) were RAC. Average total cost was $117,113 for OC, $75,741.9 for LC, and $81,996.2 for RAC. Average length of stay for each technique was 10.6 days for OC, 6.1 days for LC, and 5.1 days for RAC. The risk of a postoperative complication occurring was higher in the open procedure than a laparoscopic procedure. Conclusions: LC accounted for only 36.8% of all colectomies performed in Texas between 2013-14. OC costs twice as much as LC and increased the length of stay by nearly 4 d. LC and RAC are both associated with significantly less cost and length of stay for patients undergoing surgery, while lowering perioperative complications. Disclosures: None of the authors have any relevant disclosures.

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Section: Discussionmentioning

confidence: 74%

Utilization of Laparoscopic Colon Surgery in the Texas Inpatient Public Use Data File (PUDF)

Clapp¹,

Klingsporn²,

Harper³

et al. 2019

JSLS

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“…Laparoscopic procedures are now widely used within colorectal surgery and many would argue that it is now the standard approach that should be offered to patients (3). Laparoscopic surgery is known to reduce respiratory complications (3); even in COPD patients, despite the perceived increased risks of pneumoperitoneum (4). Reduction in post-operative pain has also been confirmed (5); as has reduced length of stay in hospital.…”

Section: Introductionmentioning

confidence: 99%

Long-term results after elective laparoscopic surgery for colorectal cancer in octogenarians

et al. 2019

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The aim of this study was to investigate the short and long term outcomes after elective laparoscopic surgery for colorectal cancer patients over 80 years of age. Methods: This was a retrospective study of all patients of 80 and above, who underwent elective colorectal resection, between January 2007 and January 2016. Data were analysed from a prospectively collected cancer database and cross checked with patient records. Determinants of survival were analysed using log rank test and Kaplan-Meier curves. Results: We identified 293 patients; 110 underwent laparoscopic surgery (LPS). LPS had significantly better overall survival (p=0.0065), disease free survival (p=0.006). The LPS group also had a shorter length of stay-9 vs. 11 days (p<0.00001), 90 day mortality-5.5 vs. 13.7 per cent (p=0.03) and required fewer blood transfusions 22.7 vs.40.4 per cent (p=0.002), when compared to open surgery (OPS). There was no difference in 30 day mortality 1.8 vs. 4.9 per cent (p=0.22), anastomotic leakage 2.3 vs 6 per cent (p=0.20) or post-operative complication rates 44.5 vs. 50.8 per cent (p=0.30). Conclusions: Laparoscopic surgery for patients in their 80s is characterised by better overall and disease free survival compared to open procedures and is associated with shorter postoperative length of stay, and significantly lower 90 day mortality. Patients operated on laparoscopically also required fewer postoperative blood transfusions.

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“…Therefore, COPD as a diminished pulmonary status was usually considered as a relative contraindication to laparoscopic major abdominal surgery. Recently, several studies reported that laparoscopic major abdominal surgery was well tolerated by patients with COPD, and no difference was found in postoperative pulmonary complications between the laparoscopic and open procedures [ 10 , 11 ]. Thus, we performed this meta-analysis to assess the safety and feasibility of laparoscopic major abdominal surgery for patients with COPD.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Major Gastrointestinal Surgery Is Safe for Properly Selected Patient with COPD: A Meta-Analysis

Guo

Cao

Ding

et al. 2019

BioMed Research International

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Background. Laparoscopy has been widely applied in gastrointestinal surgery, with benefits such as less intraoperative blood loss, faster recovery, and shorter length of hospital stay. However, it remains controversial if laparoscopic major gastrointestinal surgery could be conducted for patients with chronic obstructive pulmonary disease (COPD) which was traditionally considered as an important risk factor for postoperative pulmonary complications. The present study was conducted to review and assess the safety and feasibility of laparoscopic major abdominal surgery for patient with COPD. Materials and Methods. Databases including PubMed, EmBase, Cochrane Library, and Wan-fang were searched for all years up to Jul 1, 2018. Studies comparing perioperative results for COPD patients undergoing major gastrointestinal surgery between laparoscopic and open approaches were enrolled. Results. Laparoscopic approach was associated with less intraoperative blood loss (MD = -174.03; 95% CI: −232.16 to -115.91, P < 0.00001; P < 0.00001, I2=93% for heterogeneity) and shorter length of hospital stay (MD = -3.30; 95% CI: −3.75 to -2.86, P < 0.00001; P = 0.99, I2=0% for heterogeneity). As for pulmonary complications, laparoscopic approach was associated with lower overall pulmonary complications rate (OR = 0.58; 95% CI: 0.48 to 0.71, P < 0.00001; P = 0.42, I2=0% for heterogeneity) and lower postoperative pneumonia rate (OR = 0.53; 95% CI: 0.41 to 0.67, P < 0.00001; P = 0.57, I2=0% for heterogeneity). Moreover, laparoscopic approach was associated with lower wound infection (OR = 0.51; 95% CI: 0.42 to 0.63, P < 0.00001; P = 0.99, I2=0% for heterogeneity) and abdominal abscess rates (OR = 0.59; 95% CI: 0.44 to 0.79, P < 0.0004; P = 0.24, I2=30% for heterogeneity). Conclusions. Laparoscopic major gastrointestinal surgery for properly selected COPD patient was safe and feasible, with shorter term benefits.

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Respiratory complications after colonic procedures in chronic obstructive pulmonary disease: does laparoscopy offer a benefit?

Abstract: Despite the potential risks of laparoscopic pneumoperitoneum in the susceptible COPD population, a minimally invasive approach was associated with lower risk of postoperative respiratory complications, shorter length of stay, and decrease in postoperative morbidity.

Cited by 18 publications

References 15 publications

Utilization of Laparoscopic Colon Surgery in the Texas Inpatient Public Use Data File (PUDF)

Utilization of Laparoscopic Colon Surgery in the Texas Inpatient Public Use Data File (PUDF)

Long-term results after elective laparoscopic surgery for colorectal cancer in octogenarians

Laparoscopic Major Gastrointestinal Surgery Is Safe for Properly Selected Patient with COPD: A Meta-Analysis

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