Ahmed M Al-Mazrou1, Onur Baser2, Ravi P Kiran3,4. 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. 2. Center for Innovation and Outcomes Research, Department of Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA. 3. 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. rpk2118@cumc.columbia.edu. 4. Center for Innovation and Outcomes Research, Department of Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA. rpk2118@cumc.columbia.edu.
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.
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.
Entities:
Keywords:
Colorectal; Laparoscopy; Outcomes; Over time; Robotic technology
Authors: Aneel Damle; Rachelle N Damle; Julie M Flahive; Andrew T Schlussel; Jennifer S Davids; Paul R Sturrock; Justin A Maykel; Karim Alavi Journal: Am J Surg Date: 2017-03-21 Impact factor: 2.565
Authors: Peter E Miller; Haisar Dao; Nivedh Paluvoi; Matthew Bailey; David Margolin; Nishit Shah; H D Vargas Journal: J Am Coll Surg Date: 2016-04-19 Impact factor: 6.113
Authors: Brian Ezekian; Zhifei Sun; Mohamed A Adam; Jina Kim; Megan C Turner; Brian F Gilmore; Cecilia T Ong; Christopher R Mantyh; John Migaly Journal: J Gastrointest Surg Date: 2016-03-10 Impact factor: 3.452
Authors: Jamin K Addae; Faiz Gani; Sandy Y Fang; Elizabeth C Wick; Azah A Althumairi; Jonathan E Efron; Joseph K Canner; David M Euhus; Eric B Schneider Journal: J Surg Res Date: 2016-09-17 Impact factor: 2.192
Authors: F Corcione; C Esposito; D Cuccurullo; A Settembre; N Miranda; F Amato; F Pirozzi; P Caiazzo Journal: Surg Endosc Date: 2004-11-18 Impact factor: 4.584
Authors: Kevin J Hancock; V Suzanne Klimberg; Omar Nunez-Lopez; Aakash H Gajjar; Guillermo Gomez; Douglas S Tyler; Laila Rashidi Journal: J Robot Surg Date: 2021-02-25
Authors: Jörn-Markus Gass; Diana Daume; Fiorenzo Angehrn; Martin Bolli; Romano Schneider; Daniel Steinemann; Francesco Mongelli; Andreas Scheiwiller; Lana Fourie; Beatrice Kern; Markus von Flüe; Jürg Metzger Journal: Surg Endosc Date: 2022-01-13 Impact factor: 3.453
Authors: Elizabeth R Raskin; Deborah S Keller; Madhu L Gorrepati; Sylvie Akiel-Fu; Shilpa Mehendale; Robert K Cleary Journal: JSLS Date: 2019 Jan-Mar Impact factor: 2.172