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The robotic approach significantly reduces length of stay after colectomy: a propensity score-matched analysis.
Int J Colorectal Dis 2017; 32(10):1415-1421IJ

Abstract

PURPOSE

Robotic surgery has helped overcome several of the inherent limitations of conventional laparoscopy. The aim of this study is to identify any short-term advantage of robotic-assisted (RC) over laparoscopic colectomy (LC) using standardized nationwide data.

METHODS

Patients from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 2012-2014 datasets who underwent elective LC or RC were compared for patient demographics, comorbidity, diagnosis, extent of colon resection, operative duration, and conversion rates. Thirty-day postoperative complications and post-discharge utilization of resources, readmission, and discharge to another facility were also evaluated. Propensity score matching was used to balance the sample size in the two groups.

RESULTS

Of 35,839 LC and RC procedures, 2482 cases were eligible for propensity score matching for the statistically significant variables (standardized difference > 0.10) and 1241 colectomy procedures were assigned to each group. Most of the major, minor surgical, and medical postoperative complications were comparable between the two groups. However, RC was associated with reduced 30-day postoperative septic complications (2.3 vs. 4%, p = 0.02), hospital stay (mean: 4.8 vs. 6.3 days, p = 0.001), and discharge to another facility (3.5 vs. 5.8%, p = 0.01). RC was, however, associated with readmission within 30 days after surgery (9.4 vs. 9.1%, p = 0.049). Postoperative ileus, anastomotic leak, reoperation, reintubation, and mortality were equivalent between RC and LC.

CONCLUSION

This propensity score-matched analysis suggests that RC is associated with some recovery benefits over LC. Greater experience with the technique may allow these advantages to counter some of the cost-related concerns that have deterred the more widespread utilization of robotic technology for colectomy.

Authors+Show Affiliations

Division of Colorectal Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, Herbert Irving Pavilion building, 161 Fort Washington Avenue, Floor 8, New York, NY, 10032, USA.Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, 722 West 168th St, New York, NY, 10032, USA.Division of Colorectal Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, Herbert Irving Pavilion building, 161 Fort Washington Avenue, Floor 8, New York, NY, 10032, USA. rpk2118@cumc.columbia.edu. Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, 722 West 168th St, New York, NY, 10032, USA. rpk2118@cumc.columbia.edu. Center for Innovation and Outcomes Research, Department of Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, William Black building, 650 West 168th St, New York, NY, 10032, USA. rpk2118@cumc.columbia.edu.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28685223

Citation

Al-Mazrou, Ahmed M., et al. "The Robotic Approach Significantly Reduces Length of Stay After Colectomy: a Propensity Score-matched Analysis." International Journal of Colorectal Disease, vol. 32, no. 10, 2017, pp. 1415-1421.
Al-Mazrou AM, Chiuzan C, Kiran RP. The robotic approach significantly reduces length of stay after colectomy: a propensity score-matched analysis. Int J Colorectal Dis. 2017;32(10):1415-1421.
Al-Mazrou, A. M., Chiuzan, C., & Kiran, R. P. (2017). The robotic approach significantly reduces length of stay after colectomy: a propensity score-matched analysis. International Journal of Colorectal Disease, 32(10), pp. 1415-1421. doi:10.1007/s00384-017-2845-1.
Al-Mazrou AM, Chiuzan C, Kiran RP. The Robotic Approach Significantly Reduces Length of Stay After Colectomy: a Propensity Score-matched Analysis. Int J Colorectal Dis. 2017;32(10):1415-1421. PubMed PMID: 28685223.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The robotic approach significantly reduces length of stay after colectomy: a propensity score-matched analysis. AU - Al-Mazrou,Ahmed M, AU - Chiuzan,Codruta, AU - Kiran,Ravi P, Y1 - 2017/07/07/ PY - 2017/06/20/accepted PY - 2017/7/8/pubmed PY - 2018/7/18/medline PY - 2017/7/8/entrez KW - Colorectal surgical approach KW - Laparoscopy KW - Robotic technology KW - Short-term outcomes SP - 1415 EP - 1421 JF - International journal of colorectal disease JO - Int J Colorectal Dis VL - 32 IS - 10 N2 - PURPOSE: Robotic surgery has helped overcome several of the inherent limitations of conventional laparoscopy. The aim of this study is to identify any short-term advantage of robotic-assisted (RC) over laparoscopic colectomy (LC) using standardized nationwide data. METHODS: Patients from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 2012-2014 datasets who underwent elective LC or RC were compared for patient demographics, comorbidity, diagnosis, extent of colon resection, operative duration, and conversion rates. Thirty-day postoperative complications and post-discharge utilization of resources, readmission, and discharge to another facility were also evaluated. Propensity score matching was used to balance the sample size in the two groups. RESULTS: Of 35,839 LC and RC procedures, 2482 cases were eligible for propensity score matching for the statistically significant variables (standardized difference > 0.10) and 1241 colectomy procedures were assigned to each group. Most of the major, minor surgical, and medical postoperative complications were comparable between the two groups. However, RC was associated with reduced 30-day postoperative septic complications (2.3 vs. 4%, p = 0.02), hospital stay (mean: 4.8 vs. 6.3 days, p = 0.001), and discharge to another facility (3.5 vs. 5.8%, p = 0.01). RC was, however, associated with readmission within 30 days after surgery (9.4 vs. 9.1%, p = 0.049). Postoperative ileus, anastomotic leak, reoperation, reintubation, and mortality were equivalent between RC and LC. CONCLUSION: This propensity score-matched analysis suggests that RC is associated with some recovery benefits over LC. Greater experience with the technique may allow these advantages to counter some of the cost-related concerns that have deterred the more widespread utilization of robotic technology for colectomy. SN - 1432-1262 UR - https://www.unboundmedicine.com/medline/citation/28685223/The_robotic_approach_significantly_reduces_length_of_stay_after_colectomy:_a_propensity_score_matched_analysis_ L2 - https://dx.doi.org/10.1007/s00384-017-2845-1 DB - PRIME DP - Unbound Medicine ER -