title: Is minimally invasive colon resection better than traditional approaches?: First comprehensive national examination with propensity score matching.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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 244129 colectomies performed during the study period, 126284 (51.7%) were OCs, 116261 (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 ($11742 vs $13666) (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 ($14847 vs $11966, P<.001).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Yen-Yi
authors.initials: YY
authors.lastname: Juo
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Omar
authors.initials: O
authors.lastname: Hyder
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Melissa
authors.initials: M
authors.lastname: Camp
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Anne
authors.initials: A
authors.lastname: Lidor
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland2Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Nita
authors.initials: N
authors.lastname: Ahuja
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods*; D003108:Colonic Diseases / Q000401:mortality / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012042:Registries; D012371:Robotics / Q000379:methods*; D014481:United States / Q000453:epidemiology; D055815:Young Adult