Riesgo de morbimortalidad a 30 días comparando el abordaje laparoscópico y el abierto en la cirugía gastrointestinal de urgencias

Abstract

Background and Aims: Previous studies indicated that laparoscopic surgery could improve postoperative outcomes in acute appendicitis, acute cholecystitis, perforated gastroduodenal ulcer, or acute diverticulitis, but some reported opposite results or differences in the magnitude of improvement. A contemporary analysis using propensity score matching that compares outcomes was needed. Methods: Over six months, 38 centers (5% of all public hospitals) attending emergency general surgery patients on a 24-hour, 7-days-a-week basis enrolled all consecutive adult patients who underwent laparoscopic surgery or open approach. Results: The study included 2,645 patients with acute appendicitis (32 years [22 – 51], 44.3% women), 1,182 with acute cholecystitis (65 years [48 – 76]; 46.7% women), and 470 with gastrointestinal tract perforation (65 years [50 – 76]; 34% women). After propensity score matching, hospital stays decreased in acute appendicitis (open, two days [2 – 4]; lap, two days [1 – 4]; p<.001), acute cholecystitis (open, seven days [4 – 12]; lap, four days [3 – 6]; p<.001) and gastrointestinal tract perforation (open, 11 days [7 – 17]; lap, six days [5 – 8.5]; p<.001). A decrease in 30-day morbidity was observed in acute appendicitis (open, 15.7%; lap, 9.7%; p<.001), acute cholecystitis (open, 41%; lap, 21.7%; p<.001), and gastrointestinal tract perforation (open, 45.2%; lap, 23.5%; p<.001). A decrease in 30-day mortality was found in acute cholecystitis (open, 8.8%; lap, 2.8%; p=.013) and gastrointestinal tract perforation (open, 10.4%; lap, 1.7%; p=.013). Conclusions: This clinically based, multicenter study suggests that an initial laparoscopic approach could be considered not only in patients with acute appendicitis or acute cholecystitis but also in patients with a perforation of the gastrointestinal tract