Propensity-score-matched 30-day outcomes of laparoscopic compared to open colectomy in patients with severe chronic obstructive pulmonary disease: an ACS-NSQIP cohort analysis

BACKGROUND: The safety of laparoscopic colectomy in patients with severe chronic obstructive pulmonary disease (COPD) remains unclear. This study compared short-term outcomes of laparoscopic and open colectomy in patients with severe COPD using a large national cohort. METHODS: A retrospective cohort analysis of ACS-NSQIP data from 2011 to 2020 included adult patients with severe COPD undergoing elective colectomy for colorectal cancer, diverticulitis, or ulcerative colitis. A 1:1 propensity-score matching was performed based on significant baseline confounders. Primary outcomes were 30-day mortality and cardiopulmonary complications; secondary outcomes included other complications, readmission, return to the OR, length of stay, and operative time. A multivariable binary logistic regression of the unmatched cohort was performed to determine the independent predictors of 30-day mortality. RESULTS: Out of 7,962 eligible patients with severe COPD, 61.5% underwent laparoscopic colectomy. After matching, 3,019 patients were included in each group. Laparoscopic colectomy was associated with lower rates of 30-day mortality (2.3 vs. 3.4%, p=0.011), unplanned intubation (3.3 vs. 4.7%, p=0.007), pneumonia (4.7 vs. 6.9%, p<0.001), ventilator use ≥ 48 h (2.0 vs. 4.2%, p<0.001), and myocardial infarction (0.9 vs. 1.6%, p=0.026). Laparoscopy was associated with shorter stay (median 5 vs. 7 days) and lower rates of wound complications, sepsis, anastomotic leak, readmission, and reoperation. In the adjusted analysis, laparoscopy was independently associated with reduced 30-day mortality (OR: 0.65, 95%CI 0.47-0.90, p=0.008). CONCLUSIONS: Laparoscopic colectomy was likely safe in patients with severe COPD and was associated with significant reductions in 30-day mortality, cardiopulmonary, infectious, and surgical complications, and shorter hospitalization.