RESUMO
BACKGROUND: Colostomy creation is a common procedure performed in colon and rectal surgery. Outcomes by technique have not been well studied. OBJECTIVE: This study evaluated outcomes related to open versus laparoscopic colostomy creation. DESIGN: This was a retrospective review of patients undergoing colostomy creation using univariate and multivariate propensity score analyses. SETTINGS: Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program database were included. PATIENTS: Data on patients were obtained from the American College of Surgeons National Surgical Quality Improvement Program 2005-2011 Participant Use Data Files. MAIN OUTCOME MEASURES: We measured 30-day mortality, 30-day complications, and predictors of 30-day mortality. RESULTS: A total of 2179 subjects were in the open group and 1132 in the laparoscopic group. The open group had increased age (open, 64 years vs laparoscopic, 60 years), admission from facility (17.0% vs 14.9%), and disseminated cancer (26.1% vs 21.4%). All were statistically significant. The open group had a significantly higher percentage of emergency operations (24.9% vs 7.9%). Operative time was statistically different (81 vs 86 minutes). Thirty-day mortality was significantly higher in the open group (8.7% vs 3.5%), as was any 30-day complication (25.4% vs 17.0%). Propensity-matching analysis on elective patients only revealed that postoperative length of stay and rate of any wound complication were statistically higher in the open group. Multivariate analysis for mortality was performed on the full, elective, and propensity-matched cohorts; age >65 years and dependent functional status were associated with an increased risk of mortality in all of the models. LIMITATIONS: This study has the potential for selection bias and limited generalizability. CONCLUSIONS: Colostomy creation at American College of Surgeons National Surgical Quality Improvement Program hospitals is more commonly performed open rather than laparoscopically. Patient age >65 years and dependent functional status are associated with an increased risk of 30-day mortality.
