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The Robotic Approach Significantly Reduces Length of Stay After Laparoscopic Colectomy: ACS NSQIP Matched Analysis
Ahmed M. Al-Mazrou*1, Cody Chiuzan2, Ravi P. Kiran1
1Division of Colorectal Surgery, Columbia University Medical Center / New York Presbyterian Hospital, New York, NY; 2Department of Biostatistics, The Mailman School of Public Health, Columbia University, New York, NY
Background: The introduction of robotic surgery has helped overcome several of the inherent technical limitations of conventional laparoscopy, by providing unique visual and mechanical features for the performance of complex colorectal procedures. The aim of this study is to identify any short-term advantage of robotic-assisted (RC) over laparoscopic colectomy (LC) using a standardized nationwide database.
Methods: Patients from the 2012-2013 American College of Surgeon (ACS) National Surgical Quality Improvement Program (NSQIP) targeted-colectomy datasets, who underwent elective LC or RC were compared for patient demographics, co-morbidity, diagnosis, extent of colon resection, operative duration, conversion rate, and postoperative complications including readmissions, reoperation and mortality. Propensity score matching using all statistically significant variables was used to balance the sample size in each group.
Results: Of 21,069 LC and RC procedures, 1094 cases were eligible for propensity score matching for the statistically significant variables (p-values ≤ 0.05) and 547 colectomy procedures were assigned to each group. Most of the major, minor, surgical and medical postoperative complications were statistically insignificant between the two groups. However, RC was associated with higher conversion rates (10.1% vs. 8%, p <0.001) but shorter postoperative hospital stay (4 days, SD [3-5] vs 5 days, SD[4-6], p <0.001) compared to LC. Postoperative ileus, anastomotic leak, readmission and mortality were equivalent between LC and RC groups.
Conclusion: The increased costs associated with the use of robotic technology, which is a current major deterrent to its widespread adoption, may potentially be counterbalanced by reduced length of stay costs. Since RC can be performed with comparable safety and efficacy even in these early stages of its adoption, further evaluation of the increased benefits of a robotic approach with growing experience and reduced conversion merits due consideration.
Outcomes after robotic-assisted vs laparoscopic surgery
| Patient characteristics | Laparoscopic (LC) | Robotic (RC) | p-value | | Age (years), mean ± SD | 60.2 ± 14.0 | 60.7 ± 13.5 | 0.529 | | Sex (male), n (%) | 292 (53.4) | 266 (48.6) | 0.116 | | Race (White), n (%) | 456 (83.4) | 458 (83.7) | 0.870 | BMI, n (%)
Underweight
Normal
Overweight
Obese | 10 (1.8)
143 (26.2)
183 (33.6)
209 (38.4) | 11 (2.0)
173 (31.8)
194 (35.7)
166 (30.5) | 0.045 | | Cardiovascular co-morbidities, n (%) | 251 (45.9) | 272 (49.7) | 0.204 | | Respiratory co-morbidities, n (%) | 25 (4.6) | 34 (6.2) | 0.228 | | Hepatic co-morbidities, n (%) | 0 (0) | 1 (0.2) | 0.317 | | Renal co-morbidities, n (%) | 2 (0.4) | 1 (0.2) | 0.563 | | Diabetes, n (%) | 64 (11.7) | 85 (15.5) | 0.064 | | Pre-op steroid/immunosuppressant use, n (%) | 22(4.0) | 21 (3.8) | 0.876 | | Pre-op mechanical bowel prep, n (%) | 345 (75.8) | 348 (74.2) | 0.569 | | Pre-op oral antibiotic, n (%) | 154 (34.2) | 174 (36.4) | 0.488 | ASA classification, n (%)
1
2
3
4
5 | 24 (4.4)
291(53.3)
214 (39.2)
17 (3.1)
0 (0) | 18 (3.3)
274 (50.1)
241 (44.1)
14 (2.6)
0 (0) | 0.353 | | Total vs Partial colectomy, n (%) | 11 (2.0) | 13 (2.4) | 0.679 | | Total operative time (>180min), n (%) | 368 (67.3) | 365 (66.7) | 0.847 | | Conversion to open surgery, n (%) | 44 (8.0) | 55 (10.1) | 0.001 | Surgical Site infection, n (%)
(Superficial, deep, or organ space) | 50 (9.1) | 48 (8.8) | 0.832 | | Wound disruption, n (%) | 2 (0.4) | 0 (0) | 0.490 | | Postoperative sepsis or septic shock, n (%) | 15 (2.7) | 15 (2.7) | 1.000 | | Post-operative ileus, n (%) | 47 (8.6) | 57 (10.4) | 0.298 | | Anastomotic leak, n (%) | 17 (3.1) | 18 (3.3) | 0.655 | | 30-day readmission, n (%) | 51 (9.3) | 52 (9.5) | 0.918 | | 30-day reoperation, n (%) | 16 (2.9) | 27 (4.9) | 0.087 | | Pneumonia, n (%) | 3 (0.6) | 8 (1.5) | 0.129 | | Myocardial infarction, n (%) | 2 (0.4) | 3 (0.6) | 0.654 | | Total length of hospital stay (days), median (IQR) | 5 (4-7) | 4 (3-5) | 0.001 | | Discharge to acute care facility, n (%) | 2 (0.4) | 1 (0.2) | 0.956 | | Mortality, n (%) | 0 (0) | 1 (0.2) | 1.000 |
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