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The effect of obesity on laparoscopic and robotic-assisted colorectal surgery outcomes: an ACS-NSQIP database analysis

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Abstract

Advantages of robotic-assisted colorectal surgery have been reported, but the effect on outcomes between obese and non-obese patients undergoing laparoscopic and robotic-assisted colorectal surgery remains unclear. Patients who underwent elective laparoscopic and robotic colon or rectal resections between 2012 and 2014 were identified in the ACS-NSQIP database. Propensity score matching was performed to determine the effect of obesity on laparoscopic and robotic-assisted 30-day surgical outcomes. 29,172 patients met inclusion criteria; 27,693 (94.9%) underwent laparoscopic colorectal surgery while 1479 (5.1%) underwent robotic-assisted surgery. Mean BMI was 28.4 kg/m2 and 35% of patients had a BMI ≥30 kg/m2. A 10-to-1 propensity matching of laparoscopic to robotic approaches was performed, resulting in 14,770 (90.9%) laparoscopic patients and 1477 (9.1%) robotic-assisted patients available for analysis. Robotic-assisted surgery was associated with lower conversion to laparotomy (2.4 vs 3.4%; p = 0.04) and decreased length-of-stay (4.5±3.2 vs 5.1±4.5 days; p < 0.0001). After adjusting for BMI and surgical approach, obese patients undergoing robotic-assisted surgery had a reduced odds ratio for developing prolonged ileus (p = 0.03). Robotic-assisted colorectal surgery is associated with fewer conversions to laparotomy and shorter length-of-stays compared to laparoscopic surgery. Risk of prolonged ileus is significantly reduced in obese patients undergoing a robotic-assisted approach.

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Author information

Authors and Affiliations

  1. Department of Surgery, The George Washington University, Washington DC, USA

    Jeffrey N. Harr, Ivy N. Haskins & Richard L. Amdur

  2. Division of Colon and Rectal Surgery, Department of Surgery, The George Washington University Medical Center, 2150 Pennsylvania Ave, NW, Suite 6B, Washington DC, 20037, USA

    Samir Agarwal & Vincent Obias

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  1. Jeffrey N. Harr
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  2. Ivy N. Haskins
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  3. Richard L. Amdur
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  4. Samir Agarwal
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  5. Vincent Obias
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Contributions

All authors listed took part in the conception, design, analysis, and interpretation of the data obtained from the ACS-NSQIP dataset. JH and IH drafted the manuscript, RA performed the statistical analysis, and all authors critically reviewed and revised the manuscript. All authors approve this version to be published.

Corresponding author

Correspondence to Vincent Obias.

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Funding

This study did not receive any funding.

Conflict of interest

Jeffrey N. Harr declares he has no conflict of interest. Ivy N. Haskins declares she has no conflict of interest. Richard L. Amdur declares he has no conflict of interest. Samir Agarwal declares he has no conflict of interest. Vincent Obias declares he is a paid consultant for Intuitive Surgical.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Harr, J.N., Haskins, I.N., Amdur, R.L. et al. The effect of obesity on laparoscopic and robotic-assisted colorectal surgery outcomes: an ACS-NSQIP database analysis. J Robotic Surg 12, 317–323 (2018). https://doi.org/10.1007/s11701-017-0736-7

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  • DOI: https://doi.org/10.1007/s11701-017-0736-7

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