Improved outcomes using laparoscopy for emergency colectomy after mitigating bias by negative control exposure analysis

Authors

George C. Linderman, Department of Surgery, Yale School of Medicine, New Haven, CT; Applied Mathematics Program, Department of Mathematics, Yale University, New Haven, CT. Electronic address: https://twitter.com/GCLinderman.
Winston Lin, Department of Statistics and Data Science, Yale University, New Haven, CT.
Mansi R. Sanghvi, Department of Surgery, Yale School of Medicine, New Haven, CT.Follow
Robert D. Becher, Department of Surgery, Yale School of Medicine, New Haven, CT.Follow
Adrian A. Maung, Department of Surgery, Yale School of Medicine, New Haven, CT.Follow
Bishwajit Bhattacharya, Department of Surgery, Yale School of Medicine, New Haven, CT.Follow
Kimberly A. Davis, Department of Surgery, Yale School of Medicine, New Haven, CT. Electronic address: https://twitter.com/kadtraumamd.Follow
Kevin M. Schuster, Department of Surgery, Yale School of Medicine, New Haven, CT. Electronic address: kevin.schuster@yale.edu.Follow

Document Type

Article

Publication Title

Surgery

Abstract

BACKGROUND: Laparoscopy is superior to open surgery for elective colectomy, but its role in emergency colectomy remains unclear. Previous studies were small and limited by confounding because surgeons may have selected lower-risk patients for laparoscopy. We therefore studied the effect of attempting laparoscopy for emergency colectomies while adjusting for confounding using multiple techniques in a large, nationwide registry. METHODS: Using National Surgical Quality Improvement Program data, we identified emergency colectomy cases from 2014 to 2018. We first compared outcomes between patients who underwent laparoscopic versus open surgery, while adjusting for baseline variables using both propensity scores and regression. Next, we performed a negative control exposure analysis. By assuming that the group that converted to open did not benefit from the attempt at laparoscopy, we used the observed benefit to bound the effect of unmeasured confounding. RESULTS: Of 21,453 patients meeting criteria, 3,867 underwent laparoscopy, of which 1,375 converted to open. In both inverse probability of treatment weighting and regression analyses, attempting laparoscopy was associated with improved 30-day mortality, overall morbidity, anastomotic leak, surgical site infection, postoperative septic shock, and length of hospital stay compared with open surgery. These effects were consistent with the lower bounds computed from the converted group. CONCLUSION: Laparoscopic surgery for colorectal emergencies appears to improve outcomes compared with open surgery. The benefit is observed even after adjusting for both measured and unmeasured confounding using multiple statistical approaches, thus suggesting a benefit not attributable to patient selection.

First Page

305

Last Page

311

DOI

10.1016/j.surg.2021.06.048

Publication Date

2-1-2022

Recommended Citation

Linderman, George C.; Lin, Winston; Sanghvi, Mansi R.; Becher, Robert D.; Maung, Adrian A.; Bhattacharya, Bishwajit; Davis, Kimberly A.; and Schuster, Kevin M., "Improved outcomes using laparoscopy for emergency colectomy after mitigating bias by negative control exposure analysis" (2022). Surgery. 35.
https://scholar.bridgeporthospital.org/surgery/35

Identifier

34332782 (pubmed); 10.1016/j.surg.2021.06.048 (doi); S0039-6060(21)00681-4 (pii)