Yuki Liu, MS1, Emelline Liu, MSHS1, Jorge A Lagares-Garcia, MD, FACS, FASCRS2, Gabriel Chedister, MD3. 1Intuitive Surgical, 2Roper Hospital, 3Medical University of South Carolina
OBJECTIVES: To evaluate the rate, risk factors and impacts of conversion to open right colectomy (ORC) for both traditional laparoscopic (LRC) and robotic-assisted right colectomy (RRC) performed for right colon cancer patients.
METHODS: Patients >18 with right colon cancer undergoing elective right colectomy as the primary procedure during 2013-2105Q3 were identified from Premier Perspective Database® using ICD-9-CM diagnosis and procedures codes. Three level analyses were conducted: (1) Unadjusted and Propensity-Score Matching (PSM) adjusted conversion rates were compared between LRC and RRC groups; (2) A multivariate logistics regression was used to quantify the effect of surgical modality on conversion adjusting for patient, surgeon, and hospital level risk factors of conversion to open; and (3) impacts of conversion were assessed through comparing the 30-day perioperative outcomes and cost between the converted and non-converted groups.
RESULTS: There were 10,622 eligible patients during January 2013-September 2015. Among them, 6,024 patients underwent LRC and 662 patients underwent RRC. Both unadjusted and PSM adjusted results suggest RRC had a significantly lower conversion rate than LRC (Unadjusted: 6.8% vs. 12.3% P= < 0.0001; adjusted: 6.7% vs. 11.2%, P=0.01). The multivariate logistic regression quantified that RRC was associated with a 47% decreased odds of conversion to ORC compared with LRC (adjusted odds ratio [OR] 0.53, 95% confidence interval [CI] 0.38-0.72). Other significant preventive factors of conversion included lower patient Charlson comorbid index/CCI, high volume surgeon, colorectal specialized surgeon, and simpler concomitant procedure such as cholecystectomy. Significant risk factors of conversion included BMI>40, male gender, other concomitant colorectal resection, and previous abdominal surgery. Comparing converted to non-converted patients, conversion was found to be associated with significantly higher perioperative complication (including surgical site infection), postoperative blood transfusion, 30-day complication related readmission, longer operative time and higher perioperative 30-day cost (All P values <0.01).
CONCLUSION: Conversion to open surgery for right colon cancer patients is associated with higher perioperative complication, longer LOS, operation-room time and higher cost. Robotic assistance, high volume surgeon and surgeon with colorectal specialty are associated with decreased odds of conversion.
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[1] Other factors included in the multivariate regression: Age category (18-34, 35-44, 45-64, 65+), race, presence of benign polyps, presence of diverticulisis/diverticulosis, smoker, concomitant hernia procedures, payor, provider bed size, provider region, year
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88288
Program Number: P240
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster