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Original Investigation |

Is Minimally Invasive Colon Resection Better Than Traditional Approaches?  First Comprehensive National Examination With Propensity Score Matching

Yen-Yi Juo, MD1; Omar Hyder, MD, MS1; Adil H. Haider, MD, MPH1; Melissa Camp, MD, MPH1; Anne Lidor, MD, MPH1; Nita Ahuja, MD1,2
[+] Author Affiliations
1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
2Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Surg. 2014;149(2):177-184. doi:10.1001/jamasurg.2013.3660.
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Importance  Minimally invasive colectomies are increasingly popular options for colon resection.

Objective  To compare the perioperative outcomes and costs of robot-assisted colectomy (RC), laparoscopic colectomy (LC), and open colectomy (OC).

Design, Setting, and Participants  The US Nationwide Inpatient Sample database was used to examine outcomes and costs before and after propensity score matching across the 3 surgical approaches. This study involved a sample of US hospital discharges from 2008 to 2010 and all patients 21 years of age or older who underwent elective colectomy.

Main Outcomes and Measures  In-hospital mortality, complications, ostomy rates, conversion to open procedure, length of stay, discharge disposition, and cost.

Results  Of the 244 129 colectomies performed during the study period, 126 284 (51.7%) were OCs, 116 261 (47.6%) were LCs, and 1584 (0.6%) were RCs. In comparison with OC, LC was associated with a lower mortality rate (0.4% vs 2.0%), lower complication rate (19.8% vs 33.2%), lower ostomy rate (3.5 vs 13.0%), shorter median length of stay (4 vs 6 days), a higher routine discharge rate (86.1% vs 68.4%), and lower overall cost than OC ($11 742 vs $13 666) (all P < .05). Comparison between RC and LC showed no significant differences with respect to in-hospital mortality (0.0% vs 0.7%), complication rates (14.7% vs 18.5%), ostomy rates (3.0% vs 5.1%), conversions to open procedure (5.7% vs 9.9%), and routine discharge rates (88.7% vs 88.5%) (all P > .05). However, RC incurred a higher overall hospitalization cost than LC ($14 847 vs $11 966, P < .001).

Conclusions and Relevance  In this nationwide comparison of minimally invasive approaches for colon resection, LC demonstrated favorable clinical outcomes and lower cost than OC. Robot-assisted colectomy was equivalent in most clinical outcomes to LC but incurred a higher cost.

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Figure.
Propensity Score–Matched Comparison Between Laparoscopic Colectomy and Open Colectomy

Statistically significant differences were observed in mortality, complication, ostomy, and routine discharge rates between laparoscopic colectomy and open colectomy.

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