PSU3 The Impact of Operative Approach on Postoperative Outcomes and Health Care Utilization Following Colectomy

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To compare clinical outcomes and resource utilization between surgical approaches for colectomy. Patients ≥18 years that underwent elective inpatient left or right colectomy between 2013 - 2019 was retrospectively analyzed from the Premier Healthcare Database. Patients were classified by operative approach open (OS), minimally invasive: either laparoscopic (LS) or robotic (RS) approach. Postoperative outcomes: operative room (OR) time, hospital length of stay (LOS), rates of conversion to open surgery and mortality were assessed within index hospitalization; reoperation, complications, post-discharge readmission and hospital-based encounters were collected to 30 days post discharge. Multivariable regression models were used to compare outcomes between operative approaches adjusted for patient baseline characteristics. Among 69,576 eligible left and 66,110 right colectomy cases, the rates of operative approach by OS, LS and RS were 31.9%, 51.8% and 16.3%; and 31.3%, 56.3% and 12.4%, respectively. Median LOS was significantly longer for both left and right colectomies in OS (6 days) and LS (5 days) compared to RS (4 days; all p-values <0.001). Laparoscopic surgery was more likely to convert to open surgery than RS in left (OR [odds ratio] 2.30) and right (OR 2.13; p-values <0.001) groups. RS compared to OS and LS was associated with a significantly lower rate of ileus, anastomotic leak, overall complications, and 30 day hospital encounters. RS also demonstrated lower mortality, reoperations, post-operative bleeding, surgical site infection and readmission rates for left and right colectomies than OS. RS had significantly longer OR times than either OS or LS. This study demonstrated improved postoperative outcomes of minimally invasive colon resection over open approach. When compared to conventional laparoscopy, robotic approach had decreased LOS, rates of conversion, ileus, overall complications, and 30-day hospital encounters, but had longer OR times. Robotic surgery was utilized increasingly in colorectal surgery with outcomes equivalent and in some domains superior to LS.