Reduced Risk of Medical Morbidity and Mortality in Patients Selected for Laparoscopic Colorectal Resection in England A Population-Based Study

Weaves: To quantify the occurrence of significant medical complications following elective colorectal resection and investigate potential differences in medical morbidity following open and minimal access colorectal surgery. Design: Retrospective analysis of Hospital Episode Statistics, which is a prospectively maintained national database. Setting: All patients undergoing colorectal resection in National Health Service trusts in England. Patients: Adult patients undergoing elective or planned surgery between April 2001 and March 2008. Intervention: Colorectal resection for benign and malignant diagnoses. Main Outcome Measures: Mortality and morbidity at 30 days and 1 year following elective colorectal resection. Results: One hundred thirty-eight thousand seven hundred thirty-five elective colorectal resections were identified between the study dates. Thirty-day in-hospital mortality was 3.4% and 1.7% following conventional and laparoscopic surgery, respectively (P < .001). Overall, the 30-day postoperative medical morbidity rate was 14.6%. Use of the minimal access approach demonstrated a significant reduction in total morbidity risk at 30 days (odds ratio, 0.79; P < .001) and 365 days (odds ratio, 0.81; P < .001) following case-mix adjustment. Multiple regression analyses demonstrated that cardiorespiratory complications and venous thromboembolism occurred less frequently during the index admission and up to I year following minimal access surgery when compared with the conventional approach (P < .049). Conclusions: In this population-based study, patients selected for laparoscopic colorectal resection were associated with lower risk of mortality as well as reduced cardiorespiratory and venous thromboembolic risk than those undergoing open surgery.