Issue link: https://viewer.e-digitaledition.com/i/1487073
Why Aren't More Surgeons Using Minimally Invasive Techniques for Emergent Colorectal Surgery? BY THOMAS CROCKER A RECENT STUDY CONCLUDED THAT MINIMALLY INVA SIVE TECHNIQUES ARE A SSOCIATED WITH BE T TER OUTCOMES FOR PATIENTS WHO UNDERGO EMERGENT COLORECTAL SURGERY. THE STUDY ALSO IDENTIFIED FACTORS THAT MAY ACCOUNT FOR THE DISPARIT Y IN THE USE OF THESE TECHNIQUES FOR EMERGENT OPER ATIONS COMPARED WITH ELECTIVE SURGERIES. MINIM A LLY IN VA SI V E TECHNIQUE S, such as lapa roscopy a nd robotic surger y, have t ra n sfor med colorec t a l su rger y in recent decades. Using data f rom t he Wa shing ton state-ba sed Surg ica l Ca re a nd O ut comes A s ses sment P rog ra m (SCOA P), a 2020 st udy in t he Jour nal o f G a s t r o i n t e s t i n a l S u r g e r y f o u n d t hat , across 21,423 elective colorecta l surger ies, minima l ly inva sive surger y rat es i ncrea sed f rom 4 4% i n 2 01 1 t o 75% by 2018. The use of minima l ly inva sive tech- niques is fa r less common for emergent colorecta l surger y. A 2019 st udy in t he Jo ur n a l of S urgi ca l Research feat u r- i n g 16 , 27 7 pat ient s f rom t he F lor ida I np a t ie nt D i s c h a r ge D a t a s e t fou n d that, a mong individua ls who under went emer gent c olor e c t a l s u r ger y, 31 . 8% received minima lly invasive operations. A mong elective surger y patients, 48.1% were minima l ly inva sive ca ses. V l a d S i m i a nu , M D, M P H , FAC S , FA SCR S , Med ica l Di rec t or of Colon a nd R ec t a l Di sorder s for t he Cent er of Digestive Hea lt h at Virg inia Ma son Medica l Center in Seattle, a nd one of the aut hors of t he 2020 st udy, set out w it h col lea g ues to investigate t he dispa r it y bet ween minima l ly inva sive emergent a nd elective colorecta l surger ies. "About 1 in 4 colon resections happen emergently," Dr. Simia nu says. "In those patients, minima l ly inva sive surger y is used [much] less of ten, a nd we're tr y ing t o f i g u re out i f we cou ld get i n si g ht s i nt o w hy t h a t i s . T he t e c h nolo g y i s t here, surgeons k now how to use t hese approaches a nd we k now t hey 're ben- ef icia l for pat ient s. So why i sn't t h i s happening a s of ten in emergency ca ses, a nd pa r ticula rly in older adults, because we think the benef its of minima lly inva- sive surger y wou ld be pa r ticu la rly high in t hose fol ks? " MINIMALLY INVASIVE SURGERY YIELDS 'BIG' BENEFITS FOR EMERGENT PATIENTS Dr. Simianu and his colleagues designed a retrospective cohort study using data from 50 SCOA P-pa r ticipating hospi- t a l s . T hey a n a ly zed 6 , 91 3 emer gent colorecta l surgery cases performed at SCOAP hospitals from 2011 to 2019. The team defined minimally invasive cases based on the surgeons' intention to treat, meaning that surgeries that began using minima lly inva sive approaches were classified as minimally invasive. Surgeons were found to have used minimally invasive approaches in 23.4% of cases. The researchers stratified the cases into three age groups — patients younger than age 65, patients 65 to 74, and patients 75 and older. Overall, compared with patients who underwent open operations, patients who underwent minimally invasive surgery had a higher discharge-to-home rate (77.8% vs. 62.8%), a lower rate of adverse events (33.1% vs. 49.1%) and a shorter length of stay (a median of six days vs. eight days). Minimally invasive surgery continued to reduce adverse events across all age groups after adjustment for demographic factors, BMI and primary surgical site. The findings appeared in The American Journal of Surgery in 2022. Dr. Simianu says the results are remark- able because patients who need emergent 1 4