eP480 - Less Is More: MIS Approaches Associated with Lower Morbidity Especially in the Medically Complex

Sunday, June 2, 2024

4:24 PM – 4:29 PM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Eren Esen, MD

Resident Physician
NYU Langone Health
New York, NY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

ZG

Zoran Z. Gajic, B.A.

MSTP Trainee
NYU Langone Medical School
New York, New York, United States

Disclosure information not submitted.
DW

Daniel Wong, MD MHS

Member of the faculty
Beth Israel Deaconess Medical Center; Harvard Medical School
Boston, Massachusetts, United States

Disclosure information not submitted.
Mehmet Gulmez, MD

Postdoctoral Research Fellow
Department of Surgery, NYU Grossman School of Medicine
New York, NY, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
Chady Atallah, MD

Associate professor of surgery
NYU Langone Hospital
New York, New York, United States

Disclosure information not submitted.
AE

Arman Erkan, MD FACS

Assistant Professor of Surgery
NYU Langone Health
New York, New York, United States

Disclosure information not submitted.
BS

Bashar A. Safar, MBBS, MRCS, FACS, FASCRS

Professor of Surgery
NYU
New York, New York, United States

Disclosure information not submitted.
FR

Feza Remzi, MD

Professor of Surgery
NYU Langone Health
New York, New York, United States

Disclosure information not submitted.

Purpose/Background: Increasing adoption of minimally invasive surgery (MIS) and enhanced recovery after surgery pathways focused on restricting intravenous fluid have reduced length of stay and overall complications in colorectal surgery. However, there have been concerns about the rates of kidney injury and effects of prolonged anesthesia and pneumoperitoneum in particular the elderly and medically complex.Methods/Interventions: Patients undergoing segmental colectomy or proctectomy captured in the targeted colectomy module of ACS-NSQIP database were examined between 2015-2019. Multivariable analysis was conducted to identify predictors of postoperative major morbidity.Results/Outcomes: Overall 135132 patients were included in the analysis. 60% of patients underwent laparoscopic surgery, 26% open, and 13% robotic. Colorectal neoplasia was the leading indication (58%) followed by diverticular disease (24%). Major morbidity or death occurred in 13% of all patients. Open (aOR 1.5 [1.4-1.6] and robotic surgery 1.2 [1.1-1.3] were independently associated with an increased risk of major complication or death. Increasing age, 65-75 years (aOR 1.2 [1.1-1.2]) and < 75 years old (1.3 [1.2-1.4] was associated with morbidity. In patients with both congestive heart failure and chronic kidney disease open surgery was associated with major morbidity (aOR 1.4 [1.3-1.6]) however robotic surgery was not (aOR 1.1 [0.9-1.3]). Prolonged operating time was associated with increased of complication in all approaches. Notably rates of progressive renal insufficiency were higher in open cases.Conclusion/

Discussion: Minimally invasive approaches in colorectal surgery are associated with lower rates of morbidity. This effect is even stronger in patients with multiple comorbidities. Shorter operating times are associated with a lower risk of major morbidity or death.