BACKGROUND:
Despite the increasing use of minimally invasive surgeries (MIS) for colorectal disorders in recent years, the outcome benefit in colostomy reversal remains unclear. The aim of this study was to analyze nationwide trends in the use of MIS for colostomy reversal and to compare patient outcomes among different surgical approaches.
METHODS:
The National Inpatient Sample was queried for patients (age?18 years) who underwent elective colostomy reversal for benign disease between October 2015 and December 2020. Trends in the use of MIS were described. Multivariate linear and logistic regressions accounting for hospital sample weights were developed to examine the association between the operative approach (open as the reference, laparoscopic, and robotic) and patient outcomes, including major complications, length of stay (LOS), and hospital charges.
RESULTS:
A total of 20,740 patients underwent colostomy reversal during the study period: 17,060 (82.3%) open surgery, 2,860(13.8%) laparoscopic surgery, and 820(4.0%) robotic surgery. The proportion of robotic approaches increased >5-fold (from 2.2% to 11.1%), while the increase in laparoscopic approach was not significant (from 13.4% to 15.9%) during 2015-2020. Multivariable analysis showed that laparoscopic approach was significantly associated with a lower incidence of surgical site infection (odds ratio [OR]: 0.35, 95% CI, 0.17-0.73), peritonitis and abdominal abscess (OR: 0.46, 95% CI, 0.25-0.82), and paralytic ileus (OR: 0.67, 95% CI, 0.47-0.94), whereas no significant associations with these outcomes were observed in the use of robotic approach (Table 1). Compared with the open approach, both laparoscopic and robotic approaches were associated with 22.6% and 26.4% shorter LOS (p<.001), respectively (Table 2). Robotic approach was associated with 36.1% higher hospital charge (p<0.01).
CONCLUSIONS:
We observed trends toward increased use of MIS in colostomy reversal and clinical benefits of the laparoscopic approach in decreasing complications and shortening LOS. Future studies are warranted to evaluate the utility of robotic surgeries in colostomy reversal, given the limited clinical benefits despite higher associated costs observed in this study.
