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Unplanned Robotic-Assisted Conversion-to-Open Colorectal Surgery is Associated with Adverse Outcomes.
J Gastrointest Surg 2018; 22(6):1059-1067JG

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.

Authors+Show Affiliations

Colon and Rectal Surgery, St Joseph Mercy Hospital Ann Arbor, 5325 Elliott Dr. Suite #104, Ann Arbor, MI, 48106, USA.Colon and Rectal Surgery, St Joseph Mercy Hospital Ann Arbor, 5325 Elliott Dr. Suite #104, Ann Arbor, MI, 48106, USA.Colon and Rectal Surgery, St Joseph Mercy Hospital Ann Arbor, 5325 Elliott Dr. Suite #104, Ann Arbor, MI, 48106, USA.Colon and Rectal Surgery, St Joseph Mercy Hospital Ann Arbor, 5325 Elliott Dr. Suite #104, Ann Arbor, MI, 48106, USA.Colon and Rectal Surgery, St Joseph Mercy Hospital Ann Arbor, 5325 Elliott Dr. Suite #104, Ann Arbor, MI, 48106, USA.Colon and Rectal Surgery, St Joseph Mercy Hospital Ann Arbor, 5325 Elliott Dr. Suite #104, Ann Arbor, MI, 48106, USA. Robert.Cleary@stjoeshealth.org.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29450825

Citation

Lee, Yongjin F., et al. "Unplanned Robotic-Assisted Conversion-to-Open Colorectal Surgery Is Associated With Adverse Outcomes." Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, vol. 22, no. 6, 2018, pp. 1059-1067.
Lee YF, Albright J, Akram WM, et al. Unplanned Robotic-Assisted Conversion-to-Open Colorectal Surgery is Associated with Adverse Outcomes. J Gastrointest Surg. 2018;22(6):1059-1067.
Lee, Y. F., Albright, J., Akram, W. M., Wu, J., Ferraro, J., & Cleary, R. K. (2018). Unplanned Robotic-Assisted Conversion-to-Open Colorectal Surgery is Associated with Adverse Outcomes. Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, 22(6), pp. 1059-1067. doi:10.1007/s11605-018-3706-0.
Lee YF, et al. Unplanned Robotic-Assisted Conversion-to-Open Colorectal Surgery Is Associated With Adverse Outcomes. J Gastrointest Surg. 2018;22(6):1059-1067. PubMed PMID: 29450825.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unplanned Robotic-Assisted Conversion-to-Open Colorectal Surgery is Associated with Adverse Outcomes. AU - Lee,Yongjin F, AU - Albright,Jeremy, AU - Akram,Warqaa M, AU - Wu,Juan, AU - Ferraro,Jane, AU - Cleary,Robert K, Y1 - 2018/02/15/ PY - 2018/01/05/received PY - 2018/01/30/accepted PY - 2018/2/17/pubmed PY - 2019/7/19/medline PY - 2018/2/17/entrez KW - Colectomy KW - Colorectal KW - Conversion KW - Laparoscopic KW - Robotic SP - 1059 EP - 1067 JF - Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract JO - J. Gastrointest. Surg. VL - 22 IS - 6 N2 - 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. SN - 1873-4626 UR - https://www.unboundmedicine.com/medline/citation/29450825/Unplanned_Robotic_Assisted_Conversion_to_Open_Colorectal_Surgery_is_Associated_with_Adverse_Outcomes_ L2 - https://dx.doi.org/10.1007/s11605-018-3706-0 DB - PRIME DP - Unbound Medicine ER -