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Unplanned Robotic-Assisted Conversion-to-Open Colorectal Surgery is Associated with Adverse Outcomes

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Laparoscopic conversion-to-open colorectal surgery is associated with worse outcomes when compared to operations completed without conversion. Consequences of robotic conversion have not yet been determined. The purpose of this study is to compare short-term outcomes of converted robotic colorectal cases with those that are completed without conversion, as well as with cases done by the open approach.

Methods

The ACS-NSQIP database was queried for patients who underwent robotic completed, robotic converted-to-open, and open colorectal resection between 2012 and 2015. Propensity scores were estimated using gradient-boosted machines and converted to weights. Generalized linear models were fit using propensity score-weighted data.

Results

A total of 25,253 patients met inclusion criteria—21,356 (84.5%) open, 3663 (14.5%) robotic completed, and 234 (0.9%) conversions. Conversion rate was 6.0%. Converted cases had significantly higher 30-day mortality rate, higher complication rate, and longer hospital length of stay than completed cases. Converted patients also had significantly higher rates of the following complications: surgical site infections, cardiac complications, deep venous thrombosis, postoperative ileus, postoperative re-intubation, renal failure, and 30-day reoperation. Compared to the open approach, converted patients had significantly more cardiac complications, postoperative reintubation, and longer operating times with no significant difference in 30-day mortality.

Conclusions

Unplanned robotic conversion-to-open is associated with worse outcomes than completed cases and outcomes that more closely resemble traditional open colorectal surgery. Patients should be counseled with regard to minimally invasive conversion rates and outcomes. The continued pursuit of technological advancements that decrease the risk for conversion in minimally invasive colorectal surgery is clearly warranted.

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Authors and Affiliations

  1. Colon and Rectal Surgery, St Joseph Mercy Hospital Ann Arbor, 5325 Elliott Dr. Suite #104, Ann Arbor, MI, 48106, USA

    Yongjin F. Lee, Jeremy Albright, Warqaa M. Akram, Juan Wu, Jane Ferraro & Robert K. Cleary

Authors
  1. Yongjin F. Lee
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  2. Jeremy Albright
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  3. Warqaa M. Akram
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  4. Juan Wu
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  5. Jane Ferraro
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  6. Robert K. Cleary
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Contributions

Yonglin F Lee MD contributed to conception and design of work, interpretation of data, drafting and revision for important intellectual content, and final approval.

Jeremy Albright PhD contributed to design of work, acquisition, analysis and interpretation of data, revision for important intellectual content, and final approval.

Warqaa M Akram MD contributed to design of work, analysis and interpretation of data, drafting and revision for important intellectual content, and final approval.

Juan Wu, MS, ScD contributed to design of work, acquisition, analysis, and interpretation of data, drafting and revision for important intellectual content, and final approval.

Jane Ferraro MPP contributed to design of work, interpretation of data, drafting and revision for important intellectual content, and final approval.

Robert K Cleary MD contributed to conception and design of work, acquisition, analysis and interpretation of data, drafting and revision for important intellectual content, and final approval.

Corresponding author

Correspondence to Robert K. Cleary.

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Conflict of interest

Drs. Lee, Albright, Akram, and Wu have no conflicts of interest or financial ties to disclose. Dr. Cleary is an educational speaker and has received honoraria from Intuitive Surgical, Inc.

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Lee, Y.F., Albright, J., Akram, W.M. et al. Unplanned Robotic-Assisted Conversion-to-Open Colorectal Surgery is Associated with Adverse Outcomes. J Gastrointest Surg 22, 1059–1067 (2018). https://doi.org/10.1007/s11605-018-3706-0

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  • DOI: https://doi.org/10.1007/s11605-018-3706-0

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