title: Robotic-assisted versus laparoscopic colectomy: cost and clinical outcomes.
abstract: OBJECTIVE
  Laparoscopic colectomies, with and without robotic assistance, are performed to treat both benign and malignant colonic disease. This study compared clinical and economic outcomes for laparoscopic colectomy procedures with and without robotic assistance.
  
  
  METHODS
  Patients aged ≥18 years having primary inpatient laparoscopic colectomy procedures (cecectomy, right hemicolectomy, left hemicolectomy, and sigmoidectomy) identified by International Classification of Diseases, Ninth Edition procedure codes performed between 2009 and the second quarter of 2011 from the Premier Hospital Database were studied. Patients were matched to a control cohort using propensity scores for disease, comorbidities, and hospital characteristics and were matched 1:1 for specific colectomy procedure. The outcomes of interest were hospital cost of laparoscopic robotic-assisted colectomy compared with traditional laparoscopic colectomy, surgery time, adverse events, and length of stay.
  
  
  RESULTS
  Of 25,758 laparoscopic colectomies identified, 98% were performed without robotic assistance and 2% were performed with robotic assistance. After matching, 1066 patients remained, 533 in each group. Lengths of stay were not significantly different between the matched cohorts, nor were rates of major, minor, and/or surgical complications. Inpatient procedures with robotic assistance were significantly more costly than those without robotic assistance ($17,445 vs $15,448, P = .001). Operative times were significantly longer for robotic-assisted procedures (4.37 hours vs 3.34 hours, P < .001).
  
  
  CONCLUSIONS
  Segmental colectomies can be performed safely by either laparoscopic or robotic-assisted methods. Increased per-case hospital costs for robotic-assisted procedures and prolonged operative times suggest that further investigation is warranted when considering robotic technology for routine laparoscopic colectomies.
authors: Department of Surgery, University of Cincinnati, Cincinnati, OH, USA.
authors: Bradley R
authors: BR
authors: Davis
authors: Medical Affairs, Ethicon Endo-Surgery, Cincinnati, OH, USA.
authors: Andrew C
authors: AC
authors: Yoo
authors: Global Health Economics and Reimbursement, Edwards Lifesciences, Irvine, CA, USA.
authors: Matt
authors: M
authors: Moore
authors: S2 Statistical Solutions, Inc., 11176 Main St, Cincinnati, OH 45241, USA. candaceg@s2stats.com.
authors: Candace
authors: C
authors: Gunnarsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000191:economics* / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D065287:Robotic Surgical Procedures / Q000191:economics*; D014481:United States; D055815:Young Adult