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.