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Differences in Effectiveness and Use of Robotic Surgery in Patients Undergoing Minimally Invasive Colectomy

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

We compared patient outcomes of robot-assisted surgery (RAS) and laparoscopic colectomy without robotic assistance for colon cancer or nonmalignant polyps, comparing all patients, obese versus nonobese patients, and male versus female patients.

Methods

We used the 2013–2015 American College of Surgeons National Surgical Quality Improvement Program data to examine a composite outcome score comprised of mortality, readmission, reoperation, wound infection, bleeding transfusion, and prolonged postoperative ileus. We used propensity scores to assess potential heterogeneous treatment effects of RAS by patient obesity and sex.

Results

In all, 17.1% of the 10,844 of patients received RAS. Males were slightly more likely to receive RAS. Obese patients were equally likely to receive RAS as nonobese patients. In comparison to nonRAS, RAS was associated with a 3.1% higher adverse composite outcome score. Mortality, reoperations, wound infections, sepsis, pulmonary embolisms, deep vein thrombosis, myocardial infarction, blood transfusions, and average length of hospitalization were similar in both groups. Conversion to open surgery was 10.1% lower in RAS versus nonRAS patients, but RAS patients were in the operating room an average of 52.4 min longer. We found no statistically significant differences (p > 0.05) by obesity status and gender.

Conclusions

Worse patient outcomes and no differential improvement by sex or obesity suggest more cautious adoption of RAS.

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Acknowledgements

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Author information

Authors and Affiliations

  1. Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA

    M. Schootman & K. Ratnapradipa

  2. Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO, USA

    M. Schootman & N.O. Davidson

  3. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    S. Hendren

  4. Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA

    T. Loux

  5. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    J. M. Eberth

  6. Department of Medicine, Division of Gastroenterology, Washington University School of Medicine, Saint Louis, MO, USA

    N.O. Davidson

Authors
  1. M. Schootman
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  2. S. Hendren
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  3. T. Loux
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  4. K. Ratnapradipa
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  5. J. M. Eberth
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  6. N.O. Davidson
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Contributions

Schootman conceptualized the study, wrote the first draft of the manuscript, and performed some of the statistical analysis, and approved the final manuscript; Hendren conceptualized the study, interpreted the findings; and approved the final manuscript; Loux performed the statistical analysis, interpreted the findings, and approved the final version of the manuscript; Ratnapradipa wrote sections of the manuscript, interpreted the findings, and approved the final version of the manuscripts; Eberth conceptualized the study, interpreted the findings, and approved the final manuscript; Davidson conceptualized the study, interpreted the findings; and approved the final manuscript.

Corresponding author

Correspondence to M. Schootman.

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The authors declare that they have no conflict of interest.

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Schootman, M., Hendren, S., Loux, T. et al. Differences in Effectiveness and Use of Robotic Surgery in Patients Undergoing Minimally Invasive Colectomy. J Gastrointest Surg 21, 1296–1303 (2017). https://doi.org/10.1007/s11605-017-3460-8

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  • DOI: https://doi.org/10.1007/s11605-017-3460-8

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