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Propensity score matching analysis of laparoscopic surgery vs. open approach in 4 297 adult patients with acute appendicitis, acute cholecystitis or gastrointestinal tract perforation: a prospective multicentre study of nationwide outcomes

Previous studies indicated that laparoscopic surgery could improve postoperative outcomes in acute appendicitis, acute cholecystitis, perforated gastroduodenal ulcer, or acute diverticulitis, but some reported opposite results or differences in the magnitude of improvement. A contemporary analysis u...

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Autores principales: Lluís, Núria, Carbonell, Silvia, Villodre, Celia, Zapater, Pedro, Cantó, Miguel, Mena, Luís, Ramia, José M., Lluís, Félix
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10389196/
https://www.ncbi.nlm.nih.gov/pubmed/37060247
http://dx.doi.org/10.1097/JS9.0000000000000384
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author Lluís, Núria
Carbonell, Silvia
Villodre, Celia
Zapater, Pedro
Cantó, Miguel
Mena, Luís
Ramia, José M.
Lluís, Félix
author_facet Lluís, Núria
Carbonell, Silvia
Villodre, Celia
Zapater, Pedro
Cantó, Miguel
Mena, Luís
Ramia, José M.
Lluís, Félix
author_sort Lluís, Núria
collection PubMed
description Previous studies indicated that laparoscopic surgery could improve postoperative outcomes in acute appendicitis, acute cholecystitis, perforated gastroduodenal ulcer, or acute diverticulitis, but some reported opposite results or differences in the magnitude of improvement. A contemporary analysis using propensity score matching that compares outcomes is lacking. METHODS: Over a 6-month period, 38 centres (5% of all public hospitals) attending emergency general surgery patients on a 24 h, 7 days a week basis, enroled all consecutive adult patients who underwent laparoscopic surgery or open approach. RESULTS: The study included 2 645 patients with acute appendicitis [32 years (22–51), 44.3% women], 1 182 with acute cholecystitis [65 years (48–76); 46.7% women], and 470 with gastrointestinal tract perforation [65 years (50–76); 34% women]. After propensity score matching, hospital stays decreased in acute appendicitis [open, 2 days (2–4); lap, 2 days (1–4); P<0.001], acute cholecystitis [open, 7 days (4–12); lap, 4 days (3–6); P<0.001], and gastrointestinal tract perforation [open, 11 days (7–17); lap, 6 days (5–8.5); P<0.001]. A decrease in 30-day morbidity was observed in acute appendicitis (open, 15.7%; lap, 9.7%; P<0.001), acute cholecystitis (open, 41%; lap, 21.7%; P<0.001), and gastrointestinal tract perforation (open, 45.2%; lap, 23.5%; P<0.001). A decrease in 30-day mortality was found in acute cholecystitis (open, 8.8%; lap, 2.8%; P=0.013) and gastrointestinal tract perforation (open, 10.4%; lap, 1.7%; P=0.013). CONCLUSIONS: This clinically based, multicentre study suggests that an initial laparoscopic approach could be considered not only in patients with acute appendicitis or acute cholecystitis but also in patients with a perforation of the gastrointestinal tract.
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spelling pubmed-103891962023-08-01 Propensity score matching analysis of laparoscopic surgery vs. open approach in 4 297 adult patients with acute appendicitis, acute cholecystitis or gastrointestinal tract perforation: a prospective multicentre study of nationwide outcomes Lluís, Núria Carbonell, Silvia Villodre, Celia Zapater, Pedro Cantó, Miguel Mena, Luís Ramia, José M. Lluís, Félix Int J Surg Original Research Previous studies indicated that laparoscopic surgery could improve postoperative outcomes in acute appendicitis, acute cholecystitis, perforated gastroduodenal ulcer, or acute diverticulitis, but some reported opposite results or differences in the magnitude of improvement. A contemporary analysis using propensity score matching that compares outcomes is lacking. METHODS: Over a 6-month period, 38 centres (5% of all public hospitals) attending emergency general surgery patients on a 24 h, 7 days a week basis, enroled all consecutive adult patients who underwent laparoscopic surgery or open approach. RESULTS: The study included 2 645 patients with acute appendicitis [32 years (22–51), 44.3% women], 1 182 with acute cholecystitis [65 years (48–76); 46.7% women], and 470 with gastrointestinal tract perforation [65 years (50–76); 34% women]. After propensity score matching, hospital stays decreased in acute appendicitis [open, 2 days (2–4); lap, 2 days (1–4); P<0.001], acute cholecystitis [open, 7 days (4–12); lap, 4 days (3–6); P<0.001], and gastrointestinal tract perforation [open, 11 days (7–17); lap, 6 days (5–8.5); P<0.001]. A decrease in 30-day morbidity was observed in acute appendicitis (open, 15.7%; lap, 9.7%; P<0.001), acute cholecystitis (open, 41%; lap, 21.7%; P<0.001), and gastrointestinal tract perforation (open, 45.2%; lap, 23.5%; P<0.001). A decrease in 30-day mortality was found in acute cholecystitis (open, 8.8%; lap, 2.8%; P=0.013) and gastrointestinal tract perforation (open, 10.4%; lap, 1.7%; P=0.013). CONCLUSIONS: This clinically based, multicentre study suggests that an initial laparoscopic approach could be considered not only in patients with acute appendicitis or acute cholecystitis but also in patients with a perforation of the gastrointestinal tract. Lippincott Williams & Wilkins 2023-04-15 /pmc/articles/PMC10389196/ /pubmed/37060247 http://dx.doi.org/10.1097/JS9.0000000000000384 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Original Research
Lluís, Núria
Carbonell, Silvia
Villodre, Celia
Zapater, Pedro
Cantó, Miguel
Mena, Luís
Ramia, José M.
Lluís, Félix
Propensity score matching analysis of laparoscopic surgery vs. open approach in 4 297 adult patients with acute appendicitis, acute cholecystitis or gastrointestinal tract perforation: a prospective multicentre study of nationwide outcomes
title Propensity score matching analysis of laparoscopic surgery vs. open approach in 4 297 adult patients with acute appendicitis, acute cholecystitis or gastrointestinal tract perforation: a prospective multicentre study of nationwide outcomes
title_full Propensity score matching analysis of laparoscopic surgery vs. open approach in 4 297 adult patients with acute appendicitis, acute cholecystitis or gastrointestinal tract perforation: a prospective multicentre study of nationwide outcomes
title_fullStr Propensity score matching analysis of laparoscopic surgery vs. open approach in 4 297 adult patients with acute appendicitis, acute cholecystitis or gastrointestinal tract perforation: a prospective multicentre study of nationwide outcomes
title_full_unstemmed Propensity score matching analysis of laparoscopic surgery vs. open approach in 4 297 adult patients with acute appendicitis, acute cholecystitis or gastrointestinal tract perforation: a prospective multicentre study of nationwide outcomes
title_short Propensity score matching analysis of laparoscopic surgery vs. open approach in 4 297 adult patients with acute appendicitis, acute cholecystitis or gastrointestinal tract perforation: a prospective multicentre study of nationwide outcomes
title_sort propensity score matching analysis of laparoscopic surgery vs. open approach in 4 297 adult patients with acute appendicitis, acute cholecystitis or gastrointestinal tract perforation: a prospective multicentre study of nationwide outcomes
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10389196/
https://www.ncbi.nlm.nih.gov/pubmed/37060247
http://dx.doi.org/10.1097/JS9.0000000000000384
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