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The following is a summary of “Effect of minimally invasive surgery on thirty-day postoperative outcomes of frail patients undergoing emergency colon resections,” published in the April 2025 issue of Surgery by Khan et al. 

Frail individuals, particularly those requiring urgent or emergent colon resections, face significantly higher risks of postoperative complications and mortality. While minimally invasive surgical techniques have been associated with improved outcomes in the general colectomy population, their efficacy in frail patients remains unclear. This study aimed to evaluate the impact of surgical approach—open versus minimally invasive—on short-term outcomes in frail patients undergoing emergency colon resections. Using data from the American College of Surgeons National Surgical Quality Improvement Program between 2017 and 2021, researchers identified 11,976 frail patients, defined by a modified frailty index score of 2 or higher. 

Among them, 87.2% (10,293) underwent open surgery, while 12.7% (1,503) received a minimally invasive approach. Baseline analysis revealed that patients undergoing open colectomy presented with more comorbidities and were more frequently diagnosed with intra-abdominal sepsis (59.6%), whereas neoplasms were the leading indication among those treated with MIS (42%). To account for baseline differences and reduce confounding, inverse probability of treatment weighting was employed, resulting in balanced cohorts with standardized differences of ≤1.7%. After statistical adjustment, minimally invasive surgery was found to be independently associated with significantly better 30-day postoperative outcomes. Specifically, patients in the MIS group had a lower risk of mortality (4.6%; OR 0.95; 95% CI, 0.93–0.97; P < .001), severe complications (6.9%; OR 0.93; 95% CI, 0.90–0.95; P < .001), and overall complications (8.8%; OR 0.91; 95% CI, 0.88–0.94; P < .001). 

Additionally, there were notable reductions in septic shock (5.9%; OR 0.94; 95% CI, 0.92–0.96; P < .001), postoperative bleeding (4%; OR 0.95; 95% CI, 0.93–0.98; P < .001), and extended hospital stays exceeding 14 days (4.2%; OR 0.95; 95% CI, 0.92–0.99; P = .02). These findings underscore the clinical benefits of adopting minimally invasive techniques for emergency colon surgery in frail patients, challenging the prevailing tendency to default to open approaches in high-risk populations. The data suggest that with the availability of appropriate surgical expertise and institutional resources, MIS can be a viable and potentially superior alternative even in emergent settings. Consequently, careful patient selection, coupled with enhanced access to minimally invasive options, could play a critical role in reducing postoperative morbidity and mortality in this particularly vulnerable subset of surgical patients. 

These results advocate for a reevaluation of standard emergency colectomy protocols in frail patients, promoting broader consideration of MIS as a safe and effective treatment strategy when feasible.

Source: surgjournal.com/article/S0039-6060(24)00991-7/abstract