The robotic approach significantly reduces length of stay after colectomy: a propensity score-matched analysis

• Published in: International journal of colorectal disease Vol. 32; no. 10; pp. 1415 - 1421
• Main Authors: Al-Mazrou, Ahmed M., Chiuzan, Codruta, Kiran, Ravi P.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2017; Springer; Springer Nature B.V
• Subjects: Aged; Colectomy; Colectomy - adverse effects; Colectomy - methods; Colon; Comorbidity; Comparative analysis; Complications and side effects; Demography; Elective Surgical Procedures - adverse effects; Elective Surgical Procedures - statistics & numerical data; Female; Gastroenterology; Hepatology; Humans; Internal Medicine; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - statistics & numerical data; Length of Stay - statistics & numerical data; Male; Medical societies; Medicine; Medicine & Public Health; Middle Aged; Original Article; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; Proctology; Propensity Score; Quality control; Robotic surgery; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - statistics & numerical data; Statistical analysis; Surgery; Robotic technology; Laparoscopy; Colorectal surgical approach; Short-term outcomes
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-017-2845-1

Purpose Robotic surgery has helped overcome several of the inherent limitations of conventional laparoscopy. The aim of this study is to identify any short-term advantage of robotic-assisted (RC) over laparoscopic colectomy (LC) using standardized nationwide data. Methods Patients from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 2012–2014 datasets who underwent elective LC or RC were compared for patient demographics, comorbidity, diagnosis, extent of colon resection, operative duration, and conversion rates. Thirty-day postoperative complications and post-discharge utilization of resources, readmission, and discharge to another facility were also evaluated. Propensity score matching was used to balance the sample size in the two groups. Results Of 35,839 LC and RC procedures, 2482 cases were eligible for propensity score matching for the statistically significant variables (standardized difference > 0.10) and 1241 colectomy procedures were assigned to each group. Most of the major, minor surgical, and medical postoperative complications were comparable between the two groups. However, RC was associated with reduced 30-day postoperative septic complications (2.3 vs. 4%, p  = 0.02), hospital stay (mean: 4.8 vs. 6.3 days, p  = 0.001), and discharge to another facility (3.5 vs. 5.8%, p  = 0.01). RC was, however, associated with readmission within 30 days after surgery (9.4 vs. 9.1%, p  = 0.049). Postoperative ileus, anastomotic leak, reoperation, reintubation, and mortality were equivalent between RC and LC. Conclusion This propensity score-matched analysis suggests that RC is associated with some recovery benefits over LC. Greater experience with the technique may allow these advantages to counter some of the cost-related concerns that have deterred the more widespread utilization of robotic technology for colectomy.