Trends and surgical outcomes in laparoscopic and open peritoneal dialysis catheter insertion.

BACKGROUND

Peritoneal dialysis (PD) catheters can be inserted via open or laparoscopic techniques. Recent guidelines suggest advanced laparoscopic insertion for suitable patients, due to known catheter-related benefits, but surgical outcomes literature is lacking.

MATERIALS AND METHODS

We analyzed 11,731 PD catheter insertions from 2013 - 2018 in the National Surgical Quality Improvement Program database, including preoperative characteristics, operative details, and 30-day outcomes. Trends over time and factors associated with approach were assessed. Logistic regression examined the association between approach and postoperative mortality, complications, and length of stay.

RESULTS

Laparoscopic PD catheter insertions increased from 76.1 to 87% of cases over the study period (p < 0.0001). Compared to laparoscopic procedures, open insertions were performed in older patients (58.8 vs. 58.1 years) with higher comorbidity. After adjustment, odds of 30-day mortality (OR 1.16, 95% CI 0.72 - 1.89), surgical site infections (OR 1.18, 95% CI 0.84 - 1.66), and other complications were similar between groups, although length of stay > 7 days remained modestly higher for open procedures (OR 1.43, 95% CI 1.03 - 1.99).

CONCLUSION

Use of laparoscopic PD catheter insertion has steadily increased from 2013 - 2018. After accounting for confounders, laparoscopic and open techniques had comparable early morbidity and mortality. These real-world data indicate increasing adoption of laparoscopic insertion as the predominant approach for PD access creation.