Introduction
Patients and methods
Patients
Perioperative setting
Definition of postoperative complications
Costs of bowel preparation and SDD
Costs of hospital stay
Statistics
Results
Patient characteristics
Control cohort without SDD n = 154 | Primary cohort with SDD n = 154 | ||||
---|---|---|---|---|---|
No. (%) | Median (IQR) | No. (%) | Median (IQR) | P value | |
Age | 154 | 61.9 (51.9–71.9) | 154 | 63.1 (54.8–70.8) | 0.868 |
Gender | 0.906 | ||||
Male | 96 (62.3) | 97 (63.0) | |||
Female | 58 (37.7) | 57 (37.0) | |||
BMI | 154 | 25.5 (22.8–29.1) | 154 | 25.5 (22.6–29.0) | 0.555 |
ASA | 0.305 | ||||
I | 17 (11.0) | 17 (11.0) | |||
II | 65 (42.2) | 57 (37.0) | |||
III | 71 (46.1) | 77 (50.0) | |||
IV | 1 (0.6) | 3 (1.9) | |||
Previous operations | 0.012 | ||||
No | 66 (42.9) | 88 (57.1) | |||
Yes | 88 (57.1) | 66 (42.9) | |||
Indication | |||||
Tumor (incl. hereditary and benign) | 114 (74.0) | 116 (75.3) | |||
Ulcerative colitis | 4 (2.6) | 4 (2.6) | |||
Crohn’s disease | 9 (5.8) | 11 (7.1) | |||
Diverticulitis | 9 (5.8) | 7 (4.5) | |||
C.a. Hartmann | 12 (7.8) | 11 (7.1) | |||
Consequence of other treatment | 4 (2.6) | 4 (2.6) | |||
Others (stenosis, fistula) | 2 (1.3) | 1 (0.6) | |||
Type of disease | 0.902 | ||||
CRC | 88 (57.1) | 86 (55.8) | |||
Other malignancies | 18 (11.7) | 20 (12.9) | |||
Benign | 48 (31.2) | 48 (31.2) | |||
Neoadjuvant radiotherapy | 0.692 | ||||
No | 139 (90.3) | 141 (91.6) | |||
Yes | 15 (9.7) | 13 (8.4) | |||
Albumin preoperative [g/l] | 150 | 43.4 (39.6–46.1) | 146 | 44.2 (40.9–46.5) | 0.317 |
Control cohort without SDD n = 154 | Primary cohort with SDD n = 154 | ||||
---|---|---|---|---|---|
No. (%) | Median (IQR) | No. (%) | Median (IQR) | P value | |
Operating time (min) | 154 | 281.0 (191.8–395.5) | 154 | 312.5 (227.8–412.0) | 0.067 |
Hospital stay (d) | 154 | 11.5 (8.0–20.0) | 154 | 9.5 (8.0–14.3) | 0.137 |
Operational procedures | |||||
Ileocecal resection | 10 (6.5) | 15 (9.7) | |||
Hemicolectomy right | 42 (27.2) | 34 (22.1) | |||
Hemicolectomy left | 8 (5.2) | 8 (5.2) | |||
Sigmoid resection | 19 (12.3) | 25 (16.2) | |||
Rectal resection | 49 (31.8) | 51 (33.1) | |||
Colonic segmental resection | 3 (1.9) | 1 (0.6) | |||
Colectomy | 6 (3.9) | 6 (3.9) | |||
Reconstruction Hartmann | 12 (7.8) | 11 (7.1) | |||
Others | 5 (3.2) | 3 (1.9) | |||
Stool diversion | 0.084 | ||||
No | 123 (79.9) | 110 (71.4) | |||
Yes | 31 (20.1) | 44 (28.6) | |||
Invasiveness | 0.792 | ||||
Open | 67 (43.5) | 64 (41.6) | |||
Laparoscopic | 40 (26.0) | 33 (21.4) | |||
Robotic assisted | 34 (22.1) | 45 (29.2) | |||
Laparoscopic conversion | 10 (6.5) | 9 (5.8) | |||
Robotic conversion | 3 (1.9) | 3 (1.9) | |||
Mortality (30 d) | 0.317 | ||||
No | 153 (99.4) | 154 | |||
Yes | 1 (0.6) | 0 | |||
Morbidity (incl. SSI) | 0.133 | ||||
No | 103 (66.9) | 115 (74.7) | |||
Yes | 51 (33.1) | 39 (25.3) | |||
Clavien-Dindo score | 0.413 | ||||
0–2 | 118 (76.6) | 132 (85.7) | |||
3–5 | 36 (23.4) | 22 (14.3) | |||
Surgical site infection (SSI) | 0.009 | ||||
No | 124 (80.5) | 140 (90.9) | |||
Yes | 30 (19.5) | 14 (9.1) | |||
Major surgical complication* | 0.050 | ||||
No | 110 (71.4) | 123 (79.9) | |||
Yes | 44 (28.6) | 31 (20.1) | |||
Surgical complication detail | |||||
Anastomotic leakage | 23 (14.9) | 10 (6.5) | 0.017 | ||
Postoperative bleeding | 6 (3.9) | 5 (3.2) | |||
Abscess | 12 (7.8) | 6 (3.9) | |||
Burst abdomen | 6 (3.9) | 3 (1.9) | |||
Post-op antibiotics-associated colitis | 2 (1.3) | 2 (1.3) | |||
Others (stoma, fistula, ileus, etc.) | 15 (9.7) | 16 (10.4) | |||
Re-surgery | 0.092 | ||||
No | 123 (79.9) | 134 (87.0) | |||
Yes | 31 (20.1) | 20 (13.0) |
Morbidity and mortality
Risk factors for anastomotic leakage
Anastomotic leakage | ||||||
---|---|---|---|---|---|---|
Univariate | Multivariate | |||||
No (mean) | Yes (mean) | P value | OR | 95% CI | P value | |
Age | 60.5 | 61.1 | 0.788 | 0.753 | ||
Gender | 0.615 | 0.537 | ||||
Male | 171 | 22 | ||||
Female | 104 | 11 | ||||
BMI | 26.1 | 27.2 | 0.154 | 0.248 | ||
ASA | 0.184 | 0.141 | ||||
I/II | 142 | 13 | ||||
III/IV | 133 | 20 | ||||
Previous operations | 0.580 | |||||
No | 136 | 18 | ||||
Yes | 139 | 15 | ||||
Operating time (min) | 320.7 | 353.8 | 0.191 | |||
Height of operation | 0.166 | |||||
Colon | 191 | 19 | ||||
Rectum | 84 | 14 | ||||
Invasiveness | 0.429 | |||||
Open | 112 | 17 | ||||
Minimally invasive | 141 | 13 | ||||
Conversion | 22 | 3 | ||||
Type of disease | 0.876 | |||||
Benign | 87 | 10 | ||||
Malign | 188 | 23 | ||||
Neoadj. radiotherapy | 1.000 | |||||
No | 250 | 30 | ||||
Yes | 25 | 3 | ||||
Albumin preop g/l | 42.7 | 40.3 | 0.161 | |||
Stool diversion | 0.382 | |||||
No | 206 | 27 | ||||
Yes | 69 | 6 | ||||
SDD | 0.017 | 0.380 | 0.174–0.833 | 0.016 | ||
No | 131 | 23 | ||||
Yes | 144 | 10 |
Risk factors for surgical site infection
Surgical site infection | ||||||
---|---|---|---|---|---|---|
Univariate | Multivariate | |||||
No (mean) | Yes (mean) | P value | OR | 95% CI | P value | |
Age | 60.4 | 61.4 | 0.665 | 0.864 | ||
Gender | 0.248 | 0.054 | ||||
Male | 162 | 31 | ||||
Female | 102 | 13 | ||||
BMI | 26.2 | 26.3 | 0.758 | 0.621 | ||
ASA | 0.020 | 0.456 | ||||
I/II | 140 | 15 | ||||
III/IV | 124 | 29 | ||||
Previous operations | 0.003 | 0.267 | ||||
No | 141 | 13 | ||||
Yes | 123 | 31 | ||||
Operating time (min) | 329.8 | 290.7 | 0.206 | |||
Height of operation | 0.080 | |||||
Colon | 175 | 35 | ||||
Rectum | 89 | 9 | ||||
Invasiveness | < 0.001 | |||||
Open | 96 | 33 | ||||
Minimally invasive | 145 | 9 | 0.273 | 0.113–0.658 | 0.004 | |
Conversion | 23 | 2 | ||||
Type of disease | 0.271 | |||||
Benign | 80 | 17 | ||||
Malign | 184 | 27 | ||||
Neoadj. radiotherapy | 0.571 | |||||
No | 239 | 41 | ||||
Yes | 25 | 3 | ||||
Surgical complication | < 0.001 | 6.058 | 2.809–13.069 | < 0.001 | ||
No | 214 | 16 | ||||
Yes | 50 | 28 | ||||
Albumin preop g/l | 43.3 | 37.7 | 0.002 | 0.915 | 0.867–0.965 | 0.001 |
Stool diversion | 0.011 | 0.086 | ||||
No | 193 | 40 | ||||
Yes | 71 | 4 | ||||
SDD | 0.009 | 0.057 | ||||
No | 124 | 30 | ||||
Yes | 140 | 14 |