Colorectal surgery in Parkinson's disease--outcomes and predictors of mortality.

Abstract

Although diseases of the lower gastrointestinal tract are common in patients with Parkinson's disease, there is a paucity of data regarding postoperative outcomes after colorectal surgery. The Nationwide Inpatient Sample database (2007-2011) was utilized to analyze outcomes in patients with Parkinson's disease (PD) undergoing colorectal surgery. Main outcomes were risk-adjusted inpatient morbidity, mortality, hospital charge, and length of hospital stay. A total of 6490 patients were identified. Utilization of laparoscopic surgery in Parkinson's patients has progressively increased in frequency over the latest 5years analyzed. The most common diagnoses were colorectal malignancy (39%) and intestinal obstruction (20%). Right hemicolectomy (37%) and sigmoidectomy (30%) were the most common operations. Laparoscopy was used in 18% of Parkinson's patients and most commonly in the elective setting. 54.3% of Parkinson's patients had emergency surgery compared to 38.6% in non-Parkinson's. Overall morbidity and mortality were significantly lower after laparoscopic surgery compared to open (20 vs. 25% and 2.1 vs. 6.6%, respectively). Length of stay was significantly shorter (OR -1.86; p < 0.01) for laparoscopic operations, but there were no significant differences in risk-adjusted outcomes between laparoscopic and open groups. PD patients have high rates of morbidity and mortality after colorectal surgery; this may be because more than half of all patients in this population undergo emergent surgery. The laparoscopic approach appears to have short-term benefits in this patient population.