Predictors of Intra- and Postoperative Complications in Laparoscopic Colorectal Surgery: Results of an Expert Survey

Abstract

Background: The decision which patient should undergo laparoscopic rather than open colorectal surgery depends on weighing its benefits against its complications. We explored which criteria prognosticate complications in a laparoscopic intervention by assembling experienced visceral surgeons’ beliefs. Methods: A two-round postal survey was conducted: 21 experts in laparoscopic surgery were contacted and asked to list (first round) and weigh (second round) indicators (scale 1–10) they believed predicted intra- or postoperative complications in patients undergoing laparoscopic colorectal surgery. Median ratings and interquartile ranges (IQRs) were calculated. Rates ≧6 and IQRs ≤3 depicted an important prognostic indicator for complications. Results: Thirty-nine intraoperative and 43 postoperative listings and ratings of 19 experts (90%) were available for analysis. The experts depicted three domains of indicators (tumor, comorbidity and related institution). The strongest indicators for intraoperative complications were surgeon’s experience (median 9, IQR 8–10) and portal hypertension (median 9, IQR 7–10), and those for postoperative complications were liver cirrhosis Child B/C (median 8, IQR 7.75–10) and experience of the surgeon (median 8, IQR 7–10). Conclusion: This survey provides additional evidence of risk indicators for intra- and postoperative complications in patients undergoing laparoscopic colorectal surgery. Whether the identified indicators can be compiled into a prognostic instrument requires confirmation in a properly designed and sized study.