laparoscopic cholecystectomy decreases extra surgical site morbidity compared with open cholecystectomy: a propensity matched analysis
##plugins.themes.academic_pro.article.main##
Abstract
SUMMARY
Background : The ideal way to show treatment effectiveness is through randomized controlled trials the ‘gold standard’ in evidence-based surgery. Indeed, not all surgical studies can be designed as randomized trials, sometimes for ethical and otherwise, for practical reasons. This article aimed to compare laparoscopic cholecystectomy to open cholecystectomy, according to data from an administrative database, managed by a propensity matched analysis.
Methods : Were included all patients with cholelithiasis admitted in Department B between June 1st, 2008 and December 31st, 2009. In this study, the propensity score represented the probability that a patient would be treated by a procedure based on variables that were known or suspected to influence group assignment and was developed using multivariable logistic regression used here to match patients who had laparoscopic cholecystectomy to a control patient who had open cholecystectomy. The main outcome measure was morbidity. This was expressed as the number of patients with 1 or more complications occurring during the hospital stay or within 30 days following discharge.
Results: According to intention to treat, 535 patients had a laparoscopic approach (LC group) and 60 patients had a traditional open approach (OC group) regarding associated cardiac disease, previous laparotomy or when choledocholithiasis was suspected, however intra operative cholangiography showed that there was no choledocolithiasis. According to the propensity score, 28 patients in OC were matched with 58 in LC. Comparison between OC and LC before and after propensity matched analysis showed that OC was associated with a higher rate of Extra Surgical Site morbidity (p= 0.010), a longer median duration of intervention, post-operative stay and overall hospital stay (p= 0. 0001).
Conclusion: LC should be considered as first-line therapy to treat cholelithiasis surgically even if it becomes necessary to convert to OC because of intra operative findings.
Background : The ideal way to show treatment effectiveness is through randomized controlled trials the ‘gold standard’ in evidence-based surgery. Indeed, not all surgical studies can be designed as randomized trials, sometimes for ethical and otherwise, for practical reasons. This article aimed to compare laparoscopic cholecystectomy to open cholecystectomy, according to data from an administrative database, managed by a propensity matched analysis.
Methods : Were included all patients with cholelithiasis admitted in Department B between June 1st, 2008 and December 31st, 2009. In this study, the propensity score represented the probability that a patient would be treated by a procedure based on variables that were known or suspected to influence group assignment and was developed using multivariable logistic regression used here to match patients who had laparoscopic cholecystectomy to a control patient who had open cholecystectomy. The main outcome measure was morbidity. This was expressed as the number of patients with 1 or more complications occurring during the hospital stay or within 30 days following discharge.
Results: According to intention to treat, 535 patients had a laparoscopic approach (LC group) and 60 patients had a traditional open approach (OC group) regarding associated cardiac disease, previous laparotomy or when choledocholithiasis was suspected, however intra operative cholangiography showed that there was no choledocolithiasis. According to the propensity score, 28 patients in OC were matched with 58 in LC. Comparison between OC and LC before and after propensity matched analysis showed that OC was associated with a higher rate of Extra Surgical Site morbidity (p= 0.010), a longer median duration of intervention, post-operative stay and overall hospital stay (p= 0. 0001).
Conclusion: LC should be considered as first-line therapy to treat cholelithiasis surgically even if it becomes necessary to convert to OC because of intra operative findings.
Keywords:
Données administratives, qualité de soins, score de propension, étude comparative, cohorte, morbidité##plugins.themes.academic_pro.article.details##
References
- Horton R. Surgical research or comic opera: questions, but few answers. Lancet. 1996; 347:984-5
- Adamina M., Guller U., Weber W.P., Oertli D. Propensity scores and the surgeon Br J Surg. 2006; 93:389-94.
- Guller U.Surgical Outcomes Research Based on Administrative Data: Inferior or Complementary to Prospective Randomized Clinical Trials? World J Surg 2006; 30: 255-266
- Khalfallah M, Dougaz W, Bedoui R, Bouasker I, Chaker Y, Nouira R, Dziri C. Validation of the Lacaine-Huguier predictive score for choledocholithiasis: prospective study of 380 patients J Visc Surg. 2012;149: e66-72
- American Society of Anesthesiologists Physical Status Classification System www.asahq.org/Home/For-Members/Clinical-Information/ASAPhysical- Status-Classification-System consulted on February 10th, 2013)
- New York Heart Association Functional Classification - The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9th ed. Boston, Mass: Little, Brown & Co; 1994: 253-256
- Evans M, Pollock AV. Trials on trials: a review of trials of antibiotic prophylaxis. Arch Surg 1984;119:109-113
- Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control. 1992;20:271-274
- Parsons LS: SUGI 26: Reducing Bias in a Propensity Score Matchedpair Sample Using Greedy Matching Techniques, SAS Institute, Cary, NC, 2001
- Luellen JK, Shadish WR, Clark MH: Propensity scores: An introduction and experimental test. Eval Rev. 2005; 29:530-558
- Harboe KM, Anthonsen K, Bardram L. Validation of data and indicators in the Danish cholecystectomy database. International Journal for Quality in Health Care 2009 ; 21 : 160-8
- Dolan JP, Diggs BS, Sheppard BC, Hunter JG. The national mortality burden and significant factors associated with open and laparoscopic cholecystectomy : 1997-2006. J gastrointest Surg 2009 ; 13 : 2292-301
- Kuwabara K, Matsuda S, Ishikawa KB, Horiguchi H, Fujimori K. Comparative quality of laparoscopic and open cholecystectomy in the elderly using propensity score matching analysis. Gastroenterology Research and Practice 2010; 1-10.doi 10.1155/2010/490147
- Kelley JE, Grady Burrus R, Burns RP, Graham LD, Chandler KE. Safety, efficacy, cost, and morbidity of laparoscopic versus open cholecystectomy : A prospective analysis of 228 consecutive patients. The American Surgeon 1993; 1:23-27.
- Attwood SEA, Hill ADK, Mealy K, Stephens RB. A prospective comparison of laparoscopic versus open cholecystectomy. Annals of the Royal College of Surgeons of England 1992; 74: 397-400.
- Brune IB, Schönleben K, Omran S. Complications after laparoscopic and conventional cholecystectomy: A comparative study. HPB Surgery 1994; 8 : 19-25.
- Chau CH,Tang CN, Siu WT, Ha IPY, Li MKW. Laparoscopic cholecystectomy versus open cholecystectomy in elderly patients with acute cholecystitis: Retrospective study. Hong Kong Med J 2002; 8:394-9.
- Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Community-based appraisal of laparoscopic abdominal surgery in Japan. J Surg Res. 2011 ;165:e1-13.
- Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Community-based appraisal of laparoscopic abdominal surgery in Japan. J Surg Res. 2011 ;165:e1-13.
- de Mestral C, Rotstein OD, Laupacis A, Hoch JS, Zagorski B, Alali AS, Nathens AB. Comparative operative outcomes of early and delayed cholecystectomy for acute cholecystitis: a population-based propensity score analysis. Ann Surg. 2014;259:10-5.
- Shi HY, Lee KT, Chiu CC, Lee HH. The volume-outcome relationship in laparoscopic cholecystectomy: a population-based study using propensity score matching. Surg Endosc. 2013;27:3139-45.
- Kiviluoto T, Siren J, Luukkonen P, Kivilaakso E. Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. The Lancet 1998; 351: 321-5.
- Hamad MA, Thabet M, Badawy A, Mourad F, Abdel-Salam M, Abdel- Rahman MelT, Hafez MZ, Sherif T. Laparoscopic versus open cholecystectomy in patients with liver cirrhosis: a prospective, randomized study. J Laparoendosc Adv Surg Tech A. 2010; 20:405-9.
- Johansson M, Thune A, Nelvin L, Stiernstam M, Westman B, Lundell L. Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis. Br J Surg. 2005; 92: 44-9.
- Dauleh MI, Rahman S, Townell NH. Open versus laparoscopic cholecystectomy: a comparison of postoperative temperature. J R Coll Surg Edinb. 1995; 40: 116-8.
- Damiani G, Pinnarelli L, Sammarco A, Sommella L, Francucci M, Ricciardi W. Postoperative pulmonary function in open versus laparoscopic cholecystectomy: a meta-analysis of the Tiffenau index. Dig Surg. 2008; 25:1-7
- Laurence JM, Tran PD, Richardson AJ, Pleass HC, Lam VW. Laparoscopic or open cholecystectomy in cirrhosis: a systematic review of outcomes and meta-analysis of randomized trials HPB (Oxford). 2012; 14:153-61.
- Cheng Y, Xiong XZ, Wu SJ, Lin YX, Cheng NS Laparoscopic vs. open cholecystectomy for cirrhotic patients: a systematic review and metaanalysis Hepatogastroenterology. 2012; 59: 1727-34.
- de Goede B, Klitsie PJ, Hagen SM, van Kempen BJ, Spronk S, Metselaar HJ, Lange JF, Kazemier G. Meta-analysis of laparoscopic versus open cholecystectomy for patients with liver cirrhosis and symptomatic cholecystolithiasis. Br J Surg. 2013; 100: 209-16.
- Lonjon G, Boutron I, Trinquart L, Ahmad N, Aim F, Nizard R, Ravaud P. Comparison of treatment effect estimates from prospective nonrandomized studies with propensity score analysis and randomized controlled trials of surgical procedures. Ann Surg. 2014;259:18-25.