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Laparoscopic colorectal surgery confers lower mortality in the elderly: a systematic review and meta-analysis of 66,483 patients
- Source :
- Surgical Endoscopy. 29:322-333
- Publication Year :
- 2014
- Publisher :
- Springer Science and Business Media LLC, 2014.
-
Abstract
- Increasing life expectancy requires specific attention on geriatric patients. Data support a potential reduction of surgical morbidity for patients undergoing laparoscopic surgery as compared to conventional surgery. The aim of this study was to investigate the comparative effect of laparoscopic and open colorectal surgery on geriatric patients. A systematic review of electronic information sources was undertaken. Studies that provided outcome data on patients aged 65 years or older, subjected to laparoscopic or open colorectal surgery, were considered. Mortality, morbidity, cardiac and pulmonary complications were the outcome measures of treatment effect. The methodological quality of selected studies was independently appraised by two reviewers. Random effects model was applied to synthesize outcome data. Twenty-seven articles providing data for 66,592 patients were included in the analysis. Patients undergoing laparoscopic surgery had a decreased risk for mortality (2.2 vs. 5.4 %; OR 0.55, 95 % CI 0.44–0.67), overall morbidity (19.3 vs. 26.7 %; OR 0.54, 95 % CI 0.46–0.63), cardiac (4.7 vs. 7.7 %; OR 0.60, 95 % CI 0.39–0.92) and respiratory complications (3.9 vs. 6.3 %; OR 0.67, 95 % CI 0.47–0.95). Sensitivity analysis including reports with similar age, American Society of Anesthesiologists score and/or similar prevalence of cardiopulmonary morbidity between the laparoscopic and the open treatment arm validated the outcome estimates of the primary analysis. This analysis supports a substantial benefit for elderly patients undergoing laparoscopic in comparison with open colorectal surgery. The comparative effect of either approach on geriatric patients with pulmonary and cardiac comorbidities is a subject of further investigation.
- Subjects :
- Male
Laparoscopic surgery
medicine.medical_specialty
medicine.medical_treatment
MEDLINE
Comorbidity
Colonic Diseases
Internal medicine
Humans
Medicine
Laparoscopy
Digestive System Surgical Procedures
Aged
Aged, 80 and over
medicine.diagnostic_test
business.industry
General surgery
Hepatology
medicine.disease
Colorectal surgery
Rectal Diseases
Treatment Outcome
Meta-analysis
Female
Surgery
Morbidity
business
Abdominal surgery
Subjects
Details
- ISSN :
- 14322218 and 09302794
- Volume :
- 29
- Database :
- OpenAIRE
- Journal :
- Surgical Endoscopy
- Accession number :
- edsair.doi.dedup.....ed6c947f60f11c695465a3fb830d9e2d