Laparoscopic versus Robotic Colectomy: A National Surgical Quality Improvement Project Analysis

Scott Dolejs, MD, Eugene Ceppa, MD, Benjamin Zarzaur, MD, MPH. Indiana University School of Medicine

INTRODUCTION: Robotic surgery continues to grow nationwide with reported benefits of faster recovery, less pain, and less physiologic derangement. Studies comparing the outcomes of robotic versus laparoscopic colectomy are limited to small retrospective reviews. The purpose of this study is to determine the differences in 30-day outcomes between robotic and laparoscopic colectomies in a nationally representative sample.

METHODS AND PROCEDURES: The NSQIP colectomy specific participant use file in 2012 and 2013 was used for this study. Adults age 18 and older with CPT codes corresponding to a colectomy with an anastomosis were included. Patients were excluded if the surgeries were not elective or occurred on a hospital day greater than zero. Patients were also excluded if they had a preoperative wound infection, preoperative SIRS or sepsis, preoperative mechanical ventilation, or an ASA class of 5. Patients were stratified based on location of anastomosis (low pelvic versus not). Bivariate data analysis was performed and logistic regression modeling was conducted to calculate risk-adjusted 30-day outcomes.

RESULTS: There were a total of 15,488 laparoscopic colectomies (27% with low pelvic anastomosis and 73% with other anastomosis) and 575 robotic colectomies (49% with low pelvic anastomosis and 51% with other anastomosis). The morbidity and mortality was similar between groups (table 1). Patients undergoing robotic colectomies had a significantly higher rate of diverting ostomies, which was true in all anastomotic groups (table 1). Robotic colectomy was associated with a significantly longer operative time (46 mins, P<0.0001), but a statistically significantly decreased length of stay (0.5 days, P=0.01).

CONCLUSIONS: In a nationally representative sample comparing laparoscopic and robotic colectomies, the overall morbidity and mortality between groups was similar while length of stay was shorter by 0.5 days in the robotic colectomy group. However, robotic colectomies were associated with a two-fold higher rate of diverting ostomies. Thus, any potential advantage of robotic surgery in terms of shorter length of stay is negated by the decreased quality of life for a patient with an ostomy and the need for another operation. The reason for this relationship is unclear. Surgeon factors, patient factors, and technical factors should be considered in future studies.

Table 1
 

Robotic vs Laparoscopic Colectomy 

OR (95% CI)

P-value
Morbidity 0.8 (0.6-1.0) P=0.07
Mortality 0.6 (0.1-4.1) P=0.56
Ostomy formation 2.2 (1.6-3.0) P<0.0001

 

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