Reduced risk of medical morbidity and mortality in patients selected for laparoscopic colorectal resection in England: a population-based study.

OBJECTIVES To quantify the occurrence of significant medical complications following elective colorectal resection and investigate potential differences in medical morbidity following open and minimal access colorectal surgery. DESIGN Retrospective analysis of Hospital Episode Statistics, which is a prospectively maintained national database. SETTING All patients undergoing colorectal resection in National Health Service trusts in England. PATIENTS Adult patients undergoing elective or planned surgery between April 2001 and March 2008. INTERVENTION Colorectal resection for benign and malignant diagnoses. MAIN OUTCOME MEASURES Mortality and morbidity at 30 days and 1 year following elective colorectal resection. RESULTS One hundred thirty-eight thousand seven hundred thirty-five elective colorectal resections were identified between the study dates. Thirty-day in-hospital mortality was 3.4% and 1.7% following conventional and laparoscopic surgery, respectively (P < .001). Overall, the 30-day postoperative medical morbidity rate was 14.6%. Use of the minimal access approach demonstrated a significant reduction in total morbidity risk at 30 days (odds ratio, 0.79; P < .001) and 365 days (odds ratio, 0.81; P < .001) following case-mix adjustment. Multiple regression analyses demonstrated that cardiorespiratory complications and venous thromboembolism occurred less frequently during the index admission and up to 1 year following minimal access surgery when compared with the conventional approach (P < .049). CONCLUSIONS In this population-based study, patients selected for laparoscopic colorectal resection were associated with lower risk of mortality as well as reduced cardiorespiratory and venous thromboembolic risk than those undergoing open surgery.