Use of minimally invasive surgical (MIS) techniques in the management of patients with inflammatory bowel disease (IBD) is increasing. The aim of this study was to compare postoperative morbidity in patients who underwent planned open procedures to those who had an unplanned conversion to open. This study was a retrospective analysis of the ACS-NSQIP colectomy and proctectomy targeted databases from 2016 to 2022 in adult patients with a diagnosis of either Crohn’s disease (CD) or ulcerative colitis (UC). Patients were stratified by surgical approach, and propensity score matching was used to compare the primary outcome of 30-day overall morbidity between planned open procedures and MIS procedures converted to open. A total of 23,272 patients met the inclusion criteria. Of the 2343 robotic procedures, 181 (7.7

BACKGROUND: Locally advanced rectal cancer is treated with total neoadjuvant therapy which consists of neoadjuvant chemotherapy, radiation, and surgery. The comparative efficacy of long and short course radiotherapy within total neoadjuvant therapy remains uncertain. OBJECTIVE: Compare overall survival and pathological outcomes between patients treated with long or short course radiation as components of total neoadjuvant therapy. DESIGN: Retrospective cohort study. SETTINGS: National Cancer Database, 2018 to 2023. PATIENTS: Adults with clinical Stage II or III rectal adenocarcinoma treated with neoadjuvant chemotherapy and radiation followed by radical surgical resection. MAIN OUTCOME MEASURES: Overall survival and pathological outcomes in a propensity score matched cohort comparing long and short course radiation. RESULTS: A total of 12,462 patients met inclusion criteria; 10,740 (86.2%) received long course radiation and 1,722 (13.8%) received short course radiation. After 1:1 propensity score matching, 1,721 per group were identified. Overall survival at 48 months did not differ (log rank p = 0.397). There were no differences in pathological complete response rate, pathological tumor stage, tumor downstaging, or pathological nodal stage. The long course radiotherapy group had higher nodal downstaging (66.5 vs 62.7%, p = 0.023) and a nonsignificant trend towards lower nodal disease (N0 73.9 vs 70.7%, N1 21.5 vs 23.3%, and N2 4.6 vs 6.0%, respectively, p = 0.062). LIMITATIONS: Residual confounding from unmeasured clinical and treatment details is possible. This cohort was restricted to patients who underwent resection. CONCLUSIONS: Among locally advanced rectal cancer patients treated with total neoadjuvant therapy and radical resection, long and short course radiotherapy had similar overall survival, but long course radiotherapy patients had higher rates of nodal downstaging. These findings support the use of either long or short course radiotherapy regimens when planned resection is intended, but the clinical significance of differences in nodal downstaging remain uncertain. See Video Abstract.

BACKGROUND:Prolonged operative time during synchronous colorectal cancer with liver metastases resections may increase postoperative morbidity. OBJECTIVE:To evaluate the relationship between operative time and 30-day morbidity in synchronous colorectal cancer with liver metastases resections, and to identify the optimal operative time cutoff that may inform the decision to pursue a staged surgical approach. DESIGN:Retrospective cohort study. SETTING:Data were collected from the American College of Surgeons National Surgical Quality Improvement Program database for the years 2013 through 2022. PATIENTS:Adult patients undergoing simultaneous colorectal cancer and liver metastasis resection were included. MAIN OUTCOME MEASURES:Rates of 30-day overall and serious morbidity. RESULTS:Among 2306 patients, 58.1% were men, 64.7% were of White race, and the median age was 60 years. Most procedures were open (79.4%). The median operative time was 306 minutes (372 for robotic, 318.5 for laparoscopic, and 301 minutes for open surgeries). The 30-day overall morbidity rate was 36.6% (29.7% for minimally invasive surgeries and 38.4% for open surgeries), with serious morbidity at 20.1%. Based on the continuous (Youden Index) and binary (area under the curve) exploration of optimal operative time cutoff, the following operative time categories were created: <5, 5 to 6, 6 to 7, 7 to 8, and ≥8 hours. Multivariable analysis revealed increased risk of morbidity for operative durations >6 hours (OR 1.48; 95% CI, 1.13-1.96; p = 0.004), which rose with rising operative times. Minimally invasive cases had an increased risk of morbidity starting at ≥8 hours, whereas open resections demonstrated increased risk starting at 6 hours. Additional factors linked with morbidity included age 70 years or older, ASA classification III or IV, functional dependence, smoking, steroid use, and open approach. LIMITATIONS:Retrospective design and limitations of data from the American College of Surgeons National Surgical Quality Improvement Program database. CONCLUSIONS:This study demonstrates that 30-day morbidity increases after 6 hours in colorectal cancer with liver metastases resections, with a 2-hour difference in risk threshold between minimally invasive surgeries and open cases. These results highlight the need to manage operative duration and approach to improve outcomes for these patients. See Video Abstract . EL IMPACTO DEL TIEMPO QUIRRGICO EN LA MORBILIDAD EN RESECCIONES SINCRNICAS DE CNCER COLORRECTAL Y METSTASIS HEPTICAS:ANTECEDENTES:El tiempo quirúrgico prolongado durante la resección de cáncer colorrectal sincrónico con metástasis hepáticas puede aumentar la morbilidad posoperatoria.OBJETIVO:Evaluar la relación entre el tiempo quirúrgico y la morbilidad a los 30 días en la resección de cáncer colorrectal sincrónico con metástasis hepáticas, e identificar el tiempo quirúrgico óptimo que pueda servir de base para decidir si se debe seguir un enfoque quirúrgico por etapas.DISEÑO:Estudio de cohorte retrospectivo.ENTORNO:Los datos se recopilaron de la base de datos del Programa Nacional de Mejora de la Calidad Quirúrgica del Colegio Americano de Cirujanos para los años 2013 a 2022.PRINCIPAL MEDIDA DE RESULTADO:Tasas de morbilidad general y grave a los 30 días.RESULTADOS:De los 2306 pacientes, el 58,1 % eran hombres, el 64,7 % eran blancos y la mediana de edad era de 60 años. La mayoría de las intervenciones fueron abiertas (79,4 %). La mediana del tiempo quirúrgico fue de 306 minutos (372 para la cirugía robótica, 318,5 para la laparoscópica y 301 minutos para la abierta). La tasa de morbilidad global a los 30 días fue del 36,6 % (29,7 % para las cirugías mínimamente invasivas y 38,4 % para las abiertas), con una morbilidad grave del 20,1 %. A partir de la exploración continua (índice de Youden) y binaria (área bajo la curva) del tiempo quirúrgico óptimo, se crearon las siguientes categorías de tiempo quirúrgico: <5 horas, 5-6 horas, 6-7 horas, 7-8 horas y ≥8 horas. El análisis multivariable reveló un aumento del riesgo de morbilidad para duraciones quirúrgicas >6 horas (odds ratio: 1,48; intervalo de confianza del 95 %, 1,13-1,96; p = 0,004), que aumentaba con el aumento de la duración de la intervención. Los casos mínimamente invasivos presentaron un mayor riesgo de morbilidad a partir de las 8 horas, mientras que las resecciones abiertas mostraron un mayor riesgo a partir de las 6 horas. Otros factores relacionados con la morbilidad fueron la edad ≥70 años, la clasificación III/IV de la Sociedad Americana de Anestesiólogos, la dependencia funcional, el tabaquismo, el uso de esteroides y el abordaje abierto.LIMITACIONES:Diseño retrospectivo y limitaciones de los datos de la base de datos del Programa Nacional de Mejora de la Calidad Quirúrgica del Colegio Americano de Cirujanos.CONCLUSIÓN:Este estudio demuestra que la morbilidad a los 30 días aumenta después de 6 horas en el cáncer colorrectal con metástasis hepáticas resecadas, con una diferencia de 2 horas en el umbral de riesgo entre las cirugías mínimamente invasivas y los casos abiertos. Estos resultados destacan la necesidad de controlar la duración de la operación y el abordaje para mejorar los resultados de estos pacientes. ( AI-generated translation ).

AIM:Over the past decade, minimally invasive surgery (MIS) approaches have been increasingly utilized for simultaneous colorectal cancer (CRC) and colorectal liver metastasis (CRLM). However, the impact of conversion to open surgery during MIS remains unclear. This study evaluates 30-day postoperative overall morbidity in patients undergoing simultaneous resection for CRC and CRLM tumours. METHOD:We utilized the American College of Surgeons National Surgical Quality Improvement Program database from 2013 to 2022. Adults ≥18 years who underwent surgery for a simultaneous resection of CRC and CRLM were included. Propensity score matching was used to ascertain differences in surgical outcomes between those who underwent a planned open procedure and those who had an MIS that was converted to open. RESULTS:A total of 2306 patients were included in our study. Of these, the majority underwent a planned open procedure (n = 1831, 79.4%). Of the patients who underwent an MIS approach (n = 381, 20.6%), the majority had a laparoscopic procedure (n = 272, 71.4%) compared to a robotic approach (n = 109, 28.6%). There were significant differences between the three surgical groups by age group (P = 0.012), race (P < 0.001) and risk of procedure (P < 0.001). After propensity score matching, 94 patients remained in the planned open and MIS with conversion groups. There were no significant differences in 30-day postoperative outcomes between these two surgical groups. CONCLUSION:Postoperative surgical outcomes between planned open and MIS converted to open procedures were similar. These findings imply that an MIS approach can be attempted for simultaneous resection of CRC and CRLM without adverse outcomes.

BACKGROUND:Lower limb compartment syndrome (LLCS) is a rare but potentially devastating complication of prolonged lithotomy positioning in colorectal surgery. The mechanisms appear to be related to prolonged pressure on muscle compartments, leading to hypoperfusion followed by reperfusion injury. This study aims to identify the incidence of LLCS after colorectal surgery and identify associated risk factors to inform evidence-based prevention strategies. STUDY DESIGN:Adults from the American College of Surgeons NSQIP (2006 to 2022) undergoing colorectal surgery were included. The primary outcome was postoperative compartment syndrome leading to fasciotomy. Patients with concurrent vascular procedures and embolism diagnoses were excluded. The association between operative time and fasciotomy was assessed using multivariable logistic regression. RESULTS:Among 773,981 patients, 35 underwent fasciotomy within 2 days of their colorectal procedure. The median operative time was 388 minutes (interquartile range 165 to 539) for the fasciotomy group and 162 minutes (interquartile range 113 to 320) for the nonfasciotomy group (p < 0.001). Adjusted multivariable analysis demonstrated a time-response relationship between operative time and fasciotomy as the odds of fasciotomy were 3.5-fold higher after 3 to 5 hours and increased with longer operative time. In addition, other factors associated with fasciotomy included age younger than 50 years, American Society of Anesthesiologists class IV to V, and preoperative transfusion. CONCLUSIONS:Providers should exercise caution when operating on younger patients in lithotomy positions with an operative time more than 3 to 5 hours, as prolonged operative time is associated with an increased risk of fasciotomy. Improving awareness alongside the development of guidelines for routine intraoperative lower extremity assessment can facilitate early recognition and prevention of LLCS.

Background and ObjectivesLittle is known about the relationship between neoadjuvant chemotherapy (NAC) and perioperative morbidity for patients undergoing combined resection of rectal cancer and sLM. The purpose of this study is to determine the impact of NAC on 30-day morbidity for patients who undergo combined resection of primary rectal cancer and sLM.Materials and MethodsA retrospective cohort study of patients undergoing combined resection of primary rectal cancer and sLM between 2016 and 2020 at participating NSQIP hospitals. Multivariate logistic regression models were used to assess the relationship between NAC and 30-day morbidity rates.ResultsAmong 878 patients who underwent combined resection of primary rectal cancer and sLM, 672 (76.54%) received NAC. There were no significant differences in the rates of 30-day overall morbidity between patients who received NAC and those who did not (37.65% vs. 37.68%, p = 0.95). On adjusted analysis, there was no association between receipt of NAC and rates of overall morbidity (adjusted OR = 1.10, 95% CI 0.78-1.56, p = 0.95).ConclusionsThe receipt of NAC does not appear to be associated with increased perioperative morbidity in patients undergoing combined resection of primary rectal cancer and sLM.

Aim The purpose of this study is to assess US operative trends and outcomes of ulcerative colitis (UC) patients undergoing total proctocolectomy with ileal pouch-anal anastomosis (TPC-IPAA) or completion proctectomy with IPAA (CP-IPAA). Methods Adult UC patients who underwent TPC-IPAA or CP-IPAA were analysed retrospectively using the 2016-2020 American College of Surgeons National Surgical Quality Improvement Program database. Factors associated with 30-day overall and serious morbidity were identified using multivariable logistic regression. Results A total of 1696 patients were identified, with 958 patients (56.5%) undergoing TPC-IPAA and 738 (43.5%) undergoing CP-IPAA. A greater proportion of TPC-IPAAs were performed each year (except in 2019) compared to CP-IPAAs over the study period (P trend <0.001). Unadjusted analysis showed comparable rates of overall (20.8% vs. 24.4%, P = 0.076) and serious morbidity (14.3% vs. 12.7%, P = 0.352) between TPC-IPAA and CP-IPAA patients. Robotic TPC-IPAA had no differences in complications compared to laparoscopic and open approaches. Robotic CP-IPAA had higher anastomotic leak rates and longer hospital length of stay compared to laparoscopic and open approaches. Obesity was associated with increased odds of overall and serious morbidity for patients who underwent TPC-IPAA. Steroid/immunosuppressive therapy was associated with increased odds of overall and serious morbidity for patients who underwent CP-IPAA. Conclusions Obese patients should be informed of their increased morbidity risk and offered counselling on weight loss prior to surgery when feasible. Patients on steroid/immunosuppressive therapy within 30 days preoperatively should not undergo CP-IPAA or should delay surgery until they can be safely off those medications.

Background: The decriminalization of cannabis across the United States has led to an increased number of patients reporting cannabis use prior to surgery. However, it is unknown whether preoperative cannabis use disorder (CUD) increases the risk of postoperative complications among adult colectomy patients. Methods: Adult patients undergoing an elective colectomy were retrospectively analyzed from the National Inpatient Sample database (2004-2018). To control for potential confounders, patients with CUD, defined using ICD-9/10 codes, were propensity score matched to patients without CUD in a 1:1 ratio. The association between preoperative CUD and composite morbidity, the primary outcome of interest, was assessed. Subgroup analyses were performed after stratification by age (>= 50 years). Results: Among 432,018 adult colectomy patients, 816 (0.19%) reported preoperative CUD. The prevalence of CUD increased nearly three-fold during the study period from 0.8/1000 patients in 2004 to 2.0/1000 patients in 2018 (P-trend<0.001). After propensity score matching, patients with CUD exhibited similar rates of composite morbidity (140 of 816; 17.2%) as those without CUD (151 of 816; 18.5%) (p = 0.477). Patients with CUD also had similar anastomotic leak rates (CUD: 5.64% vs. No CUD: 6.25%; p = 0.601), hospital lengths of stay (CUD: 5 days, IQR 4-7 vs. No CUD: 5 days, IQR 4-7) (p = 0.415), and hospital charges as those without CUD. Similar findings were seen among patients aged >= 50 years in the subgroup analysis. Conclusions: Though the prevalence of CUD has increased drastically over the past 15 years, preoperative CUD was not associated with an increased risk of composite morbidity among adult patients undergoing an elective colectomy.

Background Inferior mesenteric artery ligation techniques for left colon and rectal resections include stapling, using an energy device, or suture ligation based on surgeon preference. To our knowledge, no studies have demonstrated superiority of one technique over the other. Methods This retrospective study utilized an institutional database for adult rectal cancer patients undergoing total mesorectal excision (2006–2021). The association between IMA ligation technique (stapled, energy, or suture ligation) and primary outcomes of intra- and 30-day post-operative bleeding complications necessitating transfusion were assessed. Primary and secondary outcomes were analyzed using ANOVA, Pearson's Chi-squared or Fisher's exact test when appropriate. Results Among the 769 rectal cancer patients included, 69 (8.97%) underwent stapled ligation, 281 (36.54%) underwent energy ligation, and 419 (54.59%) underwent suture ligation. Patients in the suture ligation group more frequently underwent open procedures (17.39% vs 19.22% vs 92.84%; p < 0.001) compared to the stapled and energy groups, respectively. There were no differences in intra- (5.80%, 3.20%, 7.16%; p = 0.082) or post-operative bleeding necessitating transfusion (7.25%, 7.47%, 5.73%; p = 0.634). However, there was significantly more bleeding post-operatively for patients in the energy cohort compared to the suture ligation cohort when receiving an open approach (14.81% vs 5.91%: p = 0.016). There were no differences in 30-day overall morbidity, readmission, reoperation, or length of stay between groups. Conclusions Energy and stapling of the IMA is as safe as traditional IMA suture ligation, with potential benefit of suture ligation over bipolar energy in decreasing post-operative bleeding when undergoing an open approach.

BACKGROUND:Advances in surgical practices have decreased hospital length of stay (LOS) after surgery. This study aimed to determine the safety of short-stay (≤24-hour) left colectomy for colon cancer patients in the US.STUDY DESIGN:Adult colon cancer patients who underwent elective left colectomies were identified using the American College of Surgeons NSQIP database (2012 to 2021). Patients were categorized into 4 LOS groups: LOS 1 day or less (≤24-hour short stay), 2 to 4, 5 to 6, and 7 or more. Primary outcomes were 30-day postoperative overall and serious morbidity. Secondary outcomes were 30-day mortality and readmission. Multivariable logistic regression was performed to explore the association between LOS and overall and serious morbidity.RESULTS:A total of 15,745 patients who underwent left colectomies for colon cancer were identified with 294 (1.87%) patients undergoing short stay. Short-stay patients were generally younger and healthier with lower 30-day overall morbidity rates (LOS ≤1 day: 3.74%, 2 to 4: 7.38%, 5 to 6: 16.12%, and ≥7: 37.64%, p < 0.001). Compared with patients with LOS 2 to 4 days, no differences in mortality and readmission rates were observed. On adjusted analysis, there was no statistical difference in the odds of overall (LOS 2 to 4 days: odds ratio 1.90, 95% CI 1.01 to 3.60, p = 0.049) and serious morbidity (LOS 2 to 4 days: odds ratio 0.86, 95% CI 1.42 to 1.76, p = 0.672) between the short-stay and LOS 2 to 4 days groups.CONCLUSIONS:Although currently performed at low rates in the US, short-stay left colectomy is safe for a select group of patients. Attention to patient selection, refinement of clinical pathways, and close follow-up may enable short-stay colectomies to become a more feasible reality.

Preoperative chemotherapy, or neoadjuvant therapy (NAC) can be used to improve resectability but can also have hepatotoxic effects on the future liver remnant. The purpose of this study was to investigate the impact of NAC on 30-day morbidity among patients undergoing a resection of primary colon cancer and synchronous liver metastases (sLM). This was a retrospective study using the National Surgical Quality Improvement Program database (2012–2020). The association between NAC and 30-day overall morbidity, the primary outcome, was assessed. Subgroup analyses for low and high-risk procedures were performed. Among 968 patients who underwent the combined resection, 571 (58.99

An estimated 25% of patients with colorectal cancer (CRC) present with distant metastases at the time of diagnosis, the most common site being the liver. Although prior studies have reported that a simultaneous approach to resections in these patients can lead to increased rates of complications, emerging literature shows that minimally invasive surgical (MIS) approaches can mitigate this additional morbidity. This is the first study utilizing a large national database to investigate colorectal and hepatic procedure-specific risks in robotic simultaneous resections for CRC and colorectal liver metastases (CRLM). Utilizing the ACS-NSQIP targeted colectomy, proctectomy, and hepatectomy files, 1,721 patients were identified who underwent simultaneous resections of CRC and CRLM from 2016 to 2021. Of these patients, 345 (20%) underwent resections by an MIS approach, defined as either laparoscopic (n = 266, 78%) or robotic (n = 79, 23%). Patients who underwent robotic resections had lower rates of ileus compared to those who had open surgeries. The robotic group had similar rates of 30-day anastomotic leak, bile leak, hepatic failure, and post-operative invasive hepatic procedures compared to both the open and laparoscopic groups. The rate of conversion to open (8% vs. 22%, p = 0.004) and median LOS (5 vs. 6 days, p = 0.022) was significantly lower for robotic compared to laparoscopic group. This study, which is the largest national cohort of simultaneous CRC and CRLM resections, supports the safety and potential benefits of a robotic approach in these patients.

Research on the utilization of robotic surgical approaches in the management of inflammatory bowel disease (IBD) is limited. The aims of this study were to identify temporal trends in robotic utilization and compare the safety of a robotic to laparoscopic operative approach in patients with IBD. Patients who underwent minimally invasive surgery (MIS) for IBD were identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2013–2021). Temporal trends of robotic utilization were assessed from 2013 to 2021. Primary (30-day overall and serious morbidity) and secondary (unplanned conversion to open) outcomes were assessed between 2019 and 2021, when robotic utilization was highest. Multivariable logistic regression was performed. The use of a robotic approach for colectomies and proctectomies increased significantly between 2013 and 2021 (p < 0.001), regardless of disease type. A total of 6016 patients underwent MIS for IBD between 2019 and 2021. 2234 (37

Background: The traditional treatment paradigm for patients with locally advanced rectal cancers has been neoadjuvant chemoradiation followed by curative intent surgery and adjuvant chemotherapy. This study aimed to assess surgery trends for locally advanced rectal cancers, factors associated with forgoing surgery, and overall survival outcomes.Methods: Adults with locally advanced rectal cancers were retrospectively analyzed using the National Cancer Database (2004-2019). Propensity score matching was performed. Factors associated with not undergoing surgery were identified using multivariable logistic regression. Kaplan-Meier and log-rank tests were used for 5-year overall survival analysis, stratified by stage and treatment type.Results: A total of 72,653 patients were identified, with 64,396 (88.64%) patients undergoing neoadjuvant + surgery +/- adjuvant therapy, 579 (0.80%) chemotherapy only, 916 (1.26%) radiation only, and 6,762 (9.31%) chemoradiation only. The proportion of patients who underwent surgery declined over the study period (95.61% in 2006 to 92.29% in 2019, P trend < .001), whereas the proportion of patients who refused surgery increased (1.45%-4.48%, P trend < .001). Factors associated with not undergoing surgery for locally advanced rectal cancers included older age, Black race (odds ratio 1.47, 95% CI 1.35 -1.60, P < .001), higher Charlson-Deyo score (score >3: 1.79, 1.58-2.04, P < .001), stage II cancer (1.22, 1.17-1.28, P < .001), lower median household income, and non-private insurance. Neoadjuvant + surgery +/- adjuvant therapy was associated with the best 5-year overall survival, regardless of stage, in unmatched and matched cohorts.Conclusion: Despite surgery remaining an integral component in the management of locally advanced rectal cancers, there is a concerning decline in guideline-concordant surgical care for rectal cancer in the United States, with evidence of persistent socioeconomic disparities. Providers should seek to understand patient perspectives/barriers and guide them toward surgery if appropriate candidates. Continued standardization, implementation, and evaluation of rectal cancer care through national accreditation programs are necessary to ensure that all patients receive optimal treatment. (c) 2023 Elsevier Inc. All rights reserved.

Hospital length of stay (LOS) has been used as a surgical quality metric. This study seeks to determine the safety and feasibility of right colectomy as a ≤24-h short-stay procedure for colon cancer patients. This was a retrospective cohort study using the ACS-NSQIP database and its Procedure Targeted Colectomy database (2012–2020). Adult patients with colon cancer who underwent right colectomies were identified. Patients were categorized into LOS ≤1 day (≤24-h short-stay), LOS 2–4 days, LOS 5–6 days, and LOS ≥7 days groups. Primary outcomes were 30-day overall and serious morbidity. Secondary outcomes were 30-day mortality, readmission, and anastomotic leak. The association between LOS and overall and serious morbidity was assessed using multivariable logistic regression. 19,401 adult patients were identified, with 371 patients (1.9

Background and ObjectivesOver 25% of patients diagnosed with colorectal cancer (CRC) will develop colorectal liver metastases (CRLM). Controversy exists over the surgical management of these patients. This study aims to investigate the safety of a simultaneous surgical approach by stratifying patients based on procedure risk and operative approach. MethodsUsing ACS-NSQIP (2016-2020), patients with CRC who underwent isolated colorectal, isolated hepatic, or simultaneous resections were identified. Colorectal and hepatic procedures were stratified by morbidity risk (high vs. low) and operative approach (open vs. minimally invasive). Thirty-day overall morbidity was compared between risk matched isolated and simultaneous resection groups. ResultsA total of 65 417 patients were identified, with 1550 (2.4%) undergoing simultaneous resections. A total of 1207 (77.9%) underwent a low-risk colorectal and low-risk liver resection. On multivariate analysis, there was no significant difference in overall morbidity between patients who had a simultaneous open high-risk colorectal/low-risk hepatic procedure compared to patients who had an isolated open high-risk colorectal procedure (odds ratio: 1.19; 95% confidence interval: 0.94-1.50; p = 0.148). All other combinations of simultaneous procedures had statistically significant higher rates of morbidity than the isolated group. ConclusionsSimultaneous resection of colorectal and synchronous CRLM is associated with an increased risk of morbidity in most circumstances in a risk stratified analysis, although rates of readmission and reoperation were not increased. Minimally invasive surgical approaches may significantly mitigate this morbidity.

Introduction: The purpose of this study was to assess colorectal surgery outcomes, discharge destination, and readmission in the United States during the COVID-19 pandemic.Methods: Adult colorectal surgery patients in the American College of Surgeons National Surgical Quality Improvement Program database (2019-2020) and its colectomy and proc-tectomy procedure-targeted files were included. The prepandemic time period was defined from April 1, 2019 to December 31, 2019. The pandemic time period was defined from April 1, 2020 to December 31, 2020 in quarterly intervals (Q2 April-June; Q3 July-September; Q4 October-December). Factors associated with morbidity and in-hospital mortality were assessed using multivariable logistic regression.Results: Among 62,393 patients, 34,810 patients (55.8%) underwent colorectal surgery pre -pandemic and 27,583 (44.2%) during the pandemic. Patients who had surgery during the pandemic had higher American Society of Anesthesiologists class and presented more frequently with dependent functional status. The proportion of emergent surgeries increased (12.7% prepandemic versus 15.2% pandemic, P < 0.001), with less laparoscopic cases (54.0% versus 51.0%, P < 0.001). Higher rates of morbidity with a greater proportion of discharges to home and lesser proportion of discharges to skilled care facilities were observed with no considerable differences in length of stay or worsening readmission rates. Multivariable analysis demonstrated increased odds of overall and serious morbidity and in-hospital mortality, during Q3 and/or Q4 of the 2020 pandemic.Conclusions: Differences in hospital presentation, inpatient care, and discharge disposition of colorectal surgery patients were observed during the COVID-19 pandemic. Pandemic responses should emphasize balancing resource allocation, educating patients and pro-viders on timely medical workup and management, and optimizing discharge coordination pathways.(c) 2023 Published by Elsevier Inc.

Multivisceral robotic surgery may be an alternative to sequential procedures in select patients with colorectal cancer who are diagnosed with synchronous lesions or in those who require additional procedures at the time of resection. The aim of this study was to assess utilization of the robot for multivisceral resections and compare the surgical outcomes of this approach to laparoscopic resections. Adult colorectal surgery patients who underwent a colectomy or proctectomy and a concurrent abdominal surgery procedure in the American College of Surgeons NSQIP database (2016–2021) were included. The primary outcomes were 30-day postoperative overall and serious morbidity. Factors associated with morbidity were assessed using a multivariable logistic regression. Of the 3875 patients who underwent simultaneous multivisceral resections, 397 (10.3

BACKGROUND:The worsening opioid epidemic has led to an increased number of surgical patients with chronic preoperative opioid use. However, the impact of opioids on perioperative outcomes has yet to be fully elucidated. The purpose of this study was to assess the association between preoperative opioid dose and surgical outcomes among colectomy patients.METHODS:Adult colectomy patients in the IBM MarketScan database (2010-2017) were stratified based on preoperative opioid dose, calculated as the average opioid dose in morphine milligram equivalents (MME) in the 90 days prior to surgery: 0 MME, 1 to 49 MME, and 50 or more MME. The association between preoperative opioid dose and anastomotic leak, the primary outcome of interest, as well as other postoperative complications, was assessed using multivariable regression.RESULTS:Among 45,515 adult colectomy patients, 71.4% did not use opioids (0 MME), 27.4% had an opioid dose between 1 and 49 MME, and 1.2% had an opioid dose at or above 50 MME. Patients with preoperative opioid use exhibited a higher incidence of anastomotic leak (0 MME: 4.8%, 1-49 MME: 5.5%, ≥50 MME: 8.3%; p trend = 0.001). Multivariable analysis demonstrated a dose-response relationship between preoperative opioids and surgical outcomes, as the odds of anastomotic leak worsened with increasing opioid dose (1-49 MME: OR 1.19, 95% CI 1.08-1.31, p < 0.001; ≥50 MME: OR 1.64, 95% CI 1.20-2.24, p = 0.002). Similar dose-response relationships were seen after risk-adjustment for lung complications, pneumonia, delirium, and 30-day readmission (p < 0.05 for all).CONCLUSIONS:Providers should exercise caution when prescribing opioids preoperatively, as increasing doses of preoperative opioids were associated with worse surgical outcomes and higher 30-day readmission among adult colectomy patients.