Benjamin Owen, Anton Simorov, MD, Andy Siref, Jeremy Parcells, MD, Dmitry Oleynikov, MD, FACS
University of Nebraska Medical Center
Background: Conventional laparoscopic fundoplications have been the gold standard for Nissen fundoplications for two decades. The advent of a robotic approach for fundoplication procedures creates a potential alternative. Thus, we used a national database to examine perioperative outcomes with respect to open, laparoscopic, and robotic approaches.
Methods: The University Health System Consortium is an alliance of medical centers, numbering over 115 academic institutions and their 271 affiliated hospitals. We used International Classification of Disease codes to identify patients over the age of 18 who received Nissen fundoplication procedures.
Results: A total of 12,507 patients of similar demographic background received fundoplication procedures from October 2008 to June 2012. Of those, 2,205 were open approaches (OF), 9,945 were laparoscopic (CLF), and 357 were robot-assisted (RALF). Laparoscopy had better perioperative outcomes compared to open approach with respect to mortality (0.1% vs. 0.6%, P = 0.001), morbidity (4% vs. 11%, P = 0.001), length of stay (2.8 ± 3.6 vs. 6.1 ± 7.2, P = 0.001), 30-day readmission (1.7% vs. 3.1%, P = 0.001), ICU cases (23.1% vs. 8.4%, P = 0.001), and cost ($7,968 ± $6,969 vs. $12,766 ± $13,982, P = 0.001). Laparoscopy and robot-assisted displayed no significance in mortality (0.1% vs. 0%, P = 0.5489), morbidity (4.0% vs. 5.6%, P = 0.1744), length of stay (2.8 ± 3.6 vs. 2.9 ± 3.5, P = 0.3242), and ICU cases (8.4% vs. 11.5%, P = 0.051). However, laparoscopy remained superior with a lower 30-day readmission rate (1.8% vs. 3.6%, P = 0.0215) and cost ($7,968 ± $6,969 vs. $10,644 ± $6,041, P = 0.001)
Conclusion: Current data suggests that robot-assisted Nissen fundoplication procedures do not yet have equivalent perioperative outcomes as conventional laparoscopic procedures.
Session: Podium Presentation
Program Number: S031