title: Outcomes and costs associated with robotic colectomy in the minimally invasive era.
abstract: BACKGROUND
  Robotic-assisted surgery has become increasingly common; however, it is unclear if its use for colectomy improves in-hospital outcomes compared with the laparoscopic approach.
  
  
  OBJECTIVE
  The aim of the study is to compare in-hospital outcomes and costs between patients undergoing robotic or laparoscopic colectomy.
  
  
  METHODS
  This study is a retrospective review of the 2008 to 2009 Nationwide Inpatient Sample. SETTINGS, PATIENTS, INTERVENTIONS: All adult patients who underwent an elective robotic or laparoscopic colectomy in hospitals performing both procedures (N = 2583 representing an estimated 12,732 procedures) were included.
  
  
  METHODS
  Outcomes included intraoperative and postoperative complications, length of stay, and direct costs of care. Regression models were used to compare these outcomes between procedural approaches while controlling for baseline differences in patient characteristics.
  
  
  RESULTS
  Overall, 6.1% of patients underwent a robotic procedure. Factors associated with robotic-assisted colectomy included younger age, benign diagnoses, and treatment at a lower-volume center. Patients undergoing robotic and laparoscopic procedures experienced similar rates of intraoperative (3.0% vs 3.3%; adjusted OR = 0.88 (0.35-2.22)) and postoperative (21.7% vs 21.6%; adjusted OR = 0.84 (0.54-1.30)) complications, as well as risk-adjusted average lengths of stay (5.4 vs 5.5 days, p = 0.66). However, robotic-assisted colectomy resulted in significantly higher costs of care ($19,231 vs $15,807, p < 0.001). Although the overall postoperative morbidity rate was similar between groups, the individual complications experienced by each group were different.
  
  
  CONCLUSIONS
  A limitation of this study is the potential miscoding of robotic cases in administrative data.
  
  
  CONCLUSIONS
  Robotic-assisted colectomy significantly increases the costs of care without providing clear reductions in overall morbidity or length of stay. As the use of robotic technology in colon surgery continues to evolve, critical appraisal of the benefits offered in comparison with the resources consumed is required.
authors.affiliation: Department of Surgery, San Antonio Military Medical Center, San Antonio, Texas 78234, USA. Joshua.Tyler.1@us.af.mil
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Tyler
authors.forename: Justin P
authors.initials: JP
authors.lastname: Fox
authors.forename: Mayur M
authors.initials: MM
authors.lastname: Desai
authors.forename: W Brian
authors.initials: WB
authors.lastname: Perry
authors.forename: Sean C
authors.initials: SC
authors.lastname: Glasgow
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003082:Colectomy / Q000191:economics / Q000379:methods*; D003365:Costs and Cost Analysis; D004766:Enterostomy / Q000706:statistics & numerical data; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D045823:Ileus / Q000453:epidemiology; D007412:Intestinal Fistula / Q000453:epidemiology; D007431:Intraoperative Complications / Q000191:economics; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000191:economics; D012189:Retrospective Studies; D012371:Robotics / Q000191:economics*; D054556:Venous Thromboembolism / Q000453:epidemiology; D055815:Young Adult