Predictors of intra- and postoperative complications in laparoscopic colorectal surgery: Results of an expert survey

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 lQRs <= 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. Copyright (c) 2006 S. Karger AG, Basel.