Is minimally invasive colon resection better than traditional approaches? First comprehensive national examination with propensity score matching

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 databasewas 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.