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Propensity Score-Matched Analysis of Clinical and Financial Outcomes After Robotic and Laparoscopic Colorectal Resection

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Purpose

The study aims to evaluate the clinical and financial outcomes of the use of robotic when compared to laparoscopic colorectal surgery and any changes in these over time.

Methods

From the Premier Perspective database, patients who underwent elective laparoscopic and robotic colorectal resections from 2012 to 2014 were included. Laparoscopic colorectal resections were propensity score matched to robotic cases for patient, disease, procedure, surgeon specialty, and hospital type and volume. The two groups were compared for conversion, hospital stay, 30-day post-discharge readmission, mortality, and complications. Direct, cumulative, and total (including 30-day post-discharge) costs were evaluated. Clinical and financial outcomes were also separately assessed for each of the included years.

Results

Of 36,701 patients, 32,783 (89.3%) had laparoscopic colorectal resection and 3918 (10.7%) had robotic colorectal resection; 4438 procedures (2219 in each group) were propensity score matched. For the entire period, conversion to open approach (4.7 vs. 3.7%, p = 0.1) and hospital stay (mean days [SD] 6 [5.3] vs. 5 [4.6], p = 0.2) were comparable between robotic and laparoscopic procedures. Surgical and medical complications were also the same for the two groups. However, the robotic approach was associated with lower readmission (6.3 vs. 4.8%, p = 0.04). Wound or abdominal infection (4.7 vs. 2.3%, p = 0.01) and respiratory complications (7.4 vs. 4.7%, p = 0.02) were significantly lower for the robotic group in the final year of inclusion, 2014. Direct, cumulative, and total (including 30-day post-discharge) costs were significantly higher for robotic surgery. The difference in costs between the two approaches reduced over time (direct cost difference: 2012, $2698 vs. 2013, $2235 vs. 2014, $1402).

Conclusion

Robotic colorectal surgery can be performed with comparable clinical outcomes to laparoscopy. With greater use of the technology, some further recovery benefits may be evident. The robotic approach is more expensive but cost differences have been diminishing over time.

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Authors and Affiliations

  1. Division of Colorectal Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor 8, New York, NY, 10032, USA

    Ahmed M. Al-Mazrou & Ravi P. Kiran

  2. Center for Innovation and Outcomes Research, Department of Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA

    Onur Baser & Ravi P. Kiran

Authors
  1. Ahmed M. Al-Mazrou
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  2. Onur Baser
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  3. Ravi P. Kiran
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Contributions

Ahmed M. Al-Mazrou and Ravi P. Kiran made substantial contributions to the conception and design of the project as well as acquisition, analysis, and interpretation of data, in addition to manuscript drafting and revising. Baser Onur made substantial contributions to the analysis and interpretation of data.

Corresponding author

Correspondence to Ravi P. Kiran.

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The authors declare that they have no conflict of interest.

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Al-Mazrou, A.M., Baser, O. & Kiran, R.P. Propensity Score-Matched Analysis of Clinical and Financial Outcomes After Robotic and Laparoscopic Colorectal Resection. J Gastrointest Surg 22, 1043–1051 (2018). https://doi.org/10.1007/s11605-018-3699-8

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  • DOI: https://doi.org/10.1007/s11605-018-3699-8

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