title: Evaluating quality across minimally invasive platforms in colorectal surgery.
abstract: There is an increasing emphasis on optimizing and measuring surgical quality. The safety and efficacy of minimally invasive techniques have been proven; however, direct comparison of outcomes across platforms has not been performed. Our goal was to compare operative times and quality across three minimally invasive platforms in colorectal surgery.
  
  
  
  A prospective database was reviewed for elective minimally invasive surgery (MIS) cases from 2008 to 2014. Patients were stratified into multiport laparoscopic, single-incision laparoscopic (SILS) or robotic-assisted laparoscopic approaches (RALS). Demographics, perioperative, and postoperative outcomes were analyzed. Multivariate regression analysis was used to predict the demographic and procedural factors and outcomes associated with each platform. The main outcome measures were operative time and surgical quality by approach.
  
  
  
  A total of 1055 cases were evaluated-28.4 % LAP, 18.5 % RALS, and 53.1 % SILS. RALS had the most complex patients, pathology, and procedures. The main diagnosis for RALS was rectal cancer (49.5 %), patients predominantly underwent pelvic surgery (72.8 %), had higher rates of neoadjuvant chemoradiation (p < 0.001) and stoma creation (p < 0.001). RALS had the longest operative time and highest complication and readmissions rates (all p < 0.001). Multiport patients were older than SILS and RALS (p = 0.021), had the most intraoperative complications (p < 0.001), conversions (p < 0.001), and had the longest length of stay (p = 0.001). SILS had the shortest operative times (p < 0.001), length of stay (p = 0.001), and lowest rates of complications (p < 0.001), readmissions (p < 0.001), and unplanned reoperation (p = 0.014). All platforms offered high quality (HARM score 0) from overall short LOS, low readmission, and mortality rates.
  
  
  
  Multiport, RALS, and SILS each serve a distinct demographic and disease profile and have predictable outcomes. All have risks and benefits, but offer overall high-quality care with a composite of LOS, readmission, and mortality rates. Operative times were directly associated with readmission rates. As all three platforms offer good quality, the choice of which MIS approach to use should be guided by demographics and disease process.
authors.affiliation: Colorectal Surgical Associates, Houston, TX, USA. debby_keller@hotmail.com.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Keller
authors.affiliation: Colorectal Surgical Associates, Houston, TX, USA.
authors.forename: Juan R
authors.initials: JR
authors.lastname: Flores-Gonzalez
authors.affiliation: Colorectal Surgical Associates, Houston, TX, USA.
authors.forename: Sergio
authors.initials: S
authors.lastname: Ibarra
authors.affiliation: Colorectal Surgical Associates, Houston, TX, USA.
authors.forename: Nisreen
authors.initials: N
authors.lastname: Madhoun
authors.affiliation: Colorectal Surgical Associates, Houston, TX, USA.|Minimally Invasive Colon and Rectal Surgery, The University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Reena
authors.initials: R
authors.lastname: Tahilramani
authors.affiliation: Colorectal Surgical Associates, Houston, TX, USA.|Houston Methodist Hospital, Houston, TX, USA.|Minimally Invasive Colon and Rectal Surgery, The University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Mahmood
authors.affiliation: Colorectal Surgical Associates, Houston, TX, USA.|Houston Methodist Hospital, Houston, TX, USA.|Minimally Invasive Colon and Rectal Surgery, The University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Haas
mesh_terms: D003082:Colectomy / Q000592:standards; D003108:Colonic Diseases / Q000503:physiopathology / Q000601:surgery*; D003107:Colorectal Surgery / Q000592:standards*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000592:standards*; D061646:Operative Time; D011379:Prognosis; D011446:Prospective Studies; D011787:Quality of Health Care; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome
keywords: Colorectal surgery; Laparoscopic surgery; Minimally invasive surgery; Robotic surgery; Surgical outcomes