The impact of operative approach on postoperative outcomes and healthcare utilization after colectomy

Mlambo, Busisiwe; Shih, I‐Fan; Li, Yanli; Wren, Sherry M.

doi:10.1016/j.surg.2021.07.011

Cited by 19 publications

(30 citation statements)

References 23 publications

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“…The reasons for exclusion were cohort with less than 20 RLC cases [25,[41][42][43][44][45][46], impossibility to extract data on RLC [18][19][20][21][22][23][24][36][37][38][39][40] or data overlap [26][27][28]. Eleven studies published between 2013 and 2022 were considered eligible for data extraction and were therefore included in the meta-analysis [6][7][8][9][10][11][12][13][14][15][16]. A total of 52,589 individual patients who underwent RLC (n = 13,506) or LLC (n = 39,083) were identified.…”

Section: Resultsmentioning

confidence: 99%

“…Still, few authors reported advantages also in performing this procedure: Some showed that robotic left colectomy (RLC) may be associated with lower morbidity and conversion rates along with a shorter hospital stay [6][7][8][9][10], while others found that the robotic platform offered minor advantages for this procedure [11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Robotic versus laparoscopic left colectomy: a systematic review and meta-analysis

Solaini

Bocchino

Avanzolini

et al. 2022

Int J Colorectal Dis

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Background This study aimed to review the new evidence to understand whether the robotic approach could find some clear indication also in left colectomy. Methods A systematic review of studies published from 2004 to 2022 in the Web of Science, PubMed, and Scopus databases and comparing laparoscopic (LLC) and robotic left colectomy (RLC) was performed. All comparative studies evaluating robotic left colectomy (RLC) versus laparoscopic (LLC) left colectomy with at least 20 patients in the robotic arm were included. Abstract, editorials, and reviews were excluded. The Newcastle–Ottawa Scale for cohort studies was used to assess the methodological quality. The random-effect model was used to calculate pooled effect estimates. Results Among the 139 articles identified, 11 were eligible, with a total of 52,589 patients (RLC, n = 13,506 versus LLC, n = 39,083). The rate of conversion to open surgery was lower for robotic procedures (RR 0.5, 0.5–0.6; p < 0.001). Operative time was longer for the robotic procedures in the pooled analysis (WMD 39.1, 17.3–60.9, p = 0.002). Overall complications (RR 0.9, 0.8–0.9, p < 0.001), anastomotic leaks (RR 0.7, 0.7–0.8; p < 0.001), and superficial wound infection (RR 3.1, 2.8–3.4; p < 0.001) were less common after RLC. There were no significant differences in mortality (RR 1.1; 0.8–1.6, p = 0.124). There were no differences between RLC and LLC with regards to postoperative variables in the subgroup analysis on malignancies. Conclusions Robotic left colectomy requires less conversion to open surgery than the standard laparoscopic approach. Postoperative morbidity rates seemed to be lower during RLC, but this was not confirmed in the procedures performed for malignancies.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Robotic versus laparoscopic left colectomy: a systematic review and meta-analysis

Solaini

Bocchino

Avanzolini

et al. 2022

Int J Colorectal Dis

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“…In addition, RS patients had shorter mean index hospital LOS, lower conversion-to-open surgery rates and less mean hospital outpatient visits after surgery when compared to the LS group. These findings likely reflect longterm MIS colectomy benefits that include faster recovery with fewer complications and less pain [1][2][3][4][5].…”

Section: Discussionmentioning

confidence: 91%

“…The development and introduction of minimally invasive surgery (MIS) tools and approaches have fundamentally changed colorectal surgery. MIS approaches to colorectal surgery offer several outcomes advantages over traditional open surgery (OS) that include earlier return of bowel function, less postoperative pain and opioid use, shorter hospital length of stay (LOS), and fewer surgical site infections [1][2][3][4][5]. The adoption of the MIS approach to colorectal surgery increased from 40 to 60% in 2011 to 75% in 2018 [6].…”

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confidence: 99%

Comparison of health-care utilization and expenditures for minimally invasive vs. open colectomy for benign disease

et al. 2022

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Background Adoption of minimally invasive approaches continues to increase, and there is a need to reassess outcomes and cost. We aimed to compare open versus minimally invasive colectomy short- and long-term health-care utilization and payer/patient expenditures for benign disease. Methods This is a retrospective analysis of IBM® MarketScan® Database patients who underwent left or right colectomy for benign disease between 2013 and 2018. Outcomes included total health-care expenditures, resource utilization, and direct workdays lost up to 365 days following colectomy. The open surgical approach (OS) was compared to minimally invasive colectomy (MIS) with subgroup analysis of laparoscopic (LS) and robotic (RS) approaches using inverse probability of treatment weighting. Results Of 10,439 patients, 2531 (24.3%) had open, 6826 (65.4%) had laparoscopic, and 1082 (10.3%) had robotic colectomy. MIS patients had shorter length of stay (LOS; mean difference, − 1.71, p < 0.001) and lower average total expenditures (mean difference, − $2378, p < 0.001) compared with open patients during the index hospitalization. At 1 year, MIS patients had lower readmission rates, and fewer mean emergency and outpatient department visits than open patients, translating into additional savings of $5759 and 2.22 fewer days missed from work for health-care visits over the 365-day post-discharge period. Within MIS, RS patients had shorter LOS (mean difference, − 0.60, p < 0.001) and lower conversion-to-open rates (odds ratio, 0.31 p < 0.001) during the index hospitalization, and lower hospital outpatient visits (mean difference, − 0.31, p = 0.001) at 365 days than LS. Conclusion MIS colectomy is associated with lower mean health-care expenditures and less resource utilization compared to the open approach for benign disease at index operation and 365-days post-discharge. Health-care expenditures for LS and RS are similar but shorter mean LOS and lower conversion-to-open surgery rates were observed at index operation for the RS approach.

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“…Some of the LOS benefit for robotically approached procedures may be related to fewer conversions from minimally invasive to open surgery. In an analysis of administrative data including patients who underwent right colectomy, investigators found that patients who underwent robotic as compared to laparoscopic surgery were significantly less likely to undergo conversion [ 4 ]. Similarly, data from the Norwegian Registry for Gastrointestinal Surgery and from the Norwegian Colorectal Cancer Registry also revealed lower conversion rates with robotic-assisted rectal resections compared with conventional laparoscopic resections [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Healthcare Resource Utilization After Surgical Treatment of Cancer: Value of Minimally Invasive Surgery

et al. 2022

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Background As the US healthcare system moves towards value-based care, hospitals have increased efforts to improve quality and reduce unnecessary resource use. Surgery is one of the most resource-intensive areas of healthcare and we aim to compare health resource utilization between open and minimally invasive cancer procedures. Methods We retrospectively analyzed cancer patients who underwent colon resection, rectal resection, lobectomy, or radical nephrectomy within the Premier hospital database between 2014 and 2019. Study outcomes included length of stay (LOS), discharge status, reoperation, and 30-day readmission. The open surgical approach was compared to minimally invasive approach (MIS), with subgroup analysis of laparoscopic/video-assisted thoracoscopic surgery (LAP/VATS) and robotic (RS) approaches, using inverse probability of treatment weighting. Results MIS patients had shorter LOS compared to open approach: − 1.87 days for lobectomy, − 1.34 days for colon resection, − 0.47 days for rectal resection, and − 1.21 days for radical nephrectomy (all p < .001). All MIS procedures except for rectal resection are associated with higher discharge to home rates and lower reoperation and readmission rates. Within MIS, robotic approach was further associated with shorter LOS than LAP/VATS: − 0.13 days for lobectomy, − 0.28 days for colon resection, − 0.67 days for rectal resection, and − 0.33 days for radical nephrectomy (all p < .05) and with equivalent readmission rates. Conclusion Our data demonstrate a significant shorter LOS, higher discharge to home rate, and lower rates of reoperation and readmission for MIS as compared to open procedures in patients with lung, kidney, and colorectal cancer. Patients who underwent robotic procedures had further reductions in LOS compare to laparoscopic/video-assisted thoracoscopic approach, while the reductions in LOS did not lead to increased rates of readmission.

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The impact of operative approach on postoperative outcomes and healthcare utilization after colectomy

Cited by 19 publications

References 23 publications

Robotic versus laparoscopic left colectomy: a systematic review and meta-analysis

Robotic versus laparoscopic left colectomy: a systematic review and meta-analysis

Comparison of health-care utilization and expenditures for minimally invasive vs. open colectomy for benign disease

Healthcare Resource Utilization After Surgical Treatment of Cancer: Value of Minimally Invasive Surgery

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