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The impact of operative approach on postoperative outcomes and healthcare utilization after colectomy.
- Source :
-
Surgery [Surgery] 2022 Feb; Vol. 171 (2), pp. 320-327. Date of Electronic Publication: 2021 Aug 03. - Publication Year :
- 2022
-
Abstract
- Background: To evaluate national trends in adoption of different surgical approaches for colectomy and compare clinical outcomes and resource utilization between approaches.<br />Methods: Retrospective study of patients aged ≥18 years who underwent elective inpatient left or right colectomy between 2010 and 2019 from the Premier Healthcare Database. Patients were classified by operative approach: open, minimally invasive: either laparoscopic or robotic. Postoperative outcomes assessed within index hospitalization include operating room time, hospital length of stay, rates of conversion to open surgery, reoperation, and complications. Post-discharge readmission, hospital-based encounters, and costs were collected to 30 days post-discharge. Multivariable regression models were used to compare outcomes between operative approaches adjusted for patient baseline characteristics and clustering within hospitals.<br />Results: Among 206,967 patients, the robotic approach rates increased from 2.1%/1.6% (2010) to 32.6%/26.8% (2019) for left/right colectomy, offset by a decrease in both open and laparoscopic approaches. Median length of stay for both left and right colectomies was significantly longer in open (6 days) and laparoscopic (5 days) compared to robotic surgery (4 days; all P values <.001). Robotic surgery compared to open and laparoscopic was associated with a significantly lower conversion rate, development of ileus, overall complications, and 30-day hospital encounters. Robotic surgery further demonstrated lower mortality, reoperations, postoperative bleeding, and readmission rates for left and right colectomies than open. Robotic surgery had significantly longer operating room times and higher costs than either open or laparoscopic.<br />Conclusions: Robotic surgery is increasingly being used in colon surgery, with outcomes equivalent and in some domains superior to laparoscopic.<br /> (Published by Elsevier Inc.)
- Subjects :
- Adolescent
Adult
Aged
Colectomy adverse effects
Colectomy economics
Colectomy trends
Conversion to Open Surgery adverse effects
Conversion to Open Surgery economics
Conversion to Open Surgery trends
Facilities and Services Utilization
Female
Hospital Costs
Humans
Laparoscopy adverse effects
Laparoscopy economics
Laparoscopy trends
Length of Stay
Male
Middle Aged
Operative Time
Patient Acceptance of Health Care
Patient Readmission
Postoperative Complications
Retrospective Studies
Robotic Surgical Procedures adverse effects
Robotic Surgical Procedures economics
Robotic Surgical Procedures trends
Treatment Outcome
Young Adult
Aftercare statistics & numerical data
Colectomy methods
Subjects
Details
- Language :
- English
- ISSN :
- 1532-7361
- Volume :
- 171
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 34362589
- Full Text :
- https://doi.org/10.1016/j.surg.2021.07.011