PGY3 Resident Rachel Medbery Receives SAGES Presentation Award
General surgery resident Dr. Rachel Medbery's presentation of "Impact of Operative Duration on Postoperative Pulmonary Complications in Laparoscopic vs Open Colectomy" placed first in the Top Five Residents/Fellows Best Presentation Competition held during SAGES 2013 Annual Meeting. Dr. Medbery was the first author of the study abstract, and her co-authors included Emory research informatics analyst Sebastian Perez, former resident and future Emory Surgery faculty member Dr. Ankit Patel, former endosurgery fellow Dr. Nathanial Lytle, and faculty surgeon-researchers Dr. S. Scott Davis, Dr. Edward Lin, and senior author Dr. John Sweeney.
Traditionally, prolonged operative duration is associated with increased postoperative morbidity and mortality, though laparoscopic colectomy (LC)—which typically has a longer operative duration than open colectomy (OC)—has been shown to have decreased morbidity compared to OC. The study focused on defining the direct impact of operative duration on postoperative pulmonary complications (PPC) following LC and OC, which had yet to be analyzed.
Dr. Medbery and her co-authors queried the ACS/NSQIP 2009-2010 Public Use File for patients who underwent elective LC and OC. The associations between operative duration and a PPC (pneumonia, intubation >48 hours, and unplanned intubation) as well as 30-day mortality were evaluated in 13,741 laparoscopic and 11,678 open colectomies. Overall, PPCs occurred half as often following an LC (270 [2.0%] laparoscopic vs. 497 [4.3%] open; OR 0.45, 95% CI 0.39-0.53).
While the study concluded that operative duration is independently associated with increased risk of PPC in patients undergoing LC and OC, it found that a laparoscopic approach carries half the absolute risk of PPC and, when safe, should be preferentially utilized despite a potential for prolonged operative duration.