title: Understanding the Value of Both Laparoscopic and Robotic Approaches Compared to the Open Approach in Colorectal Surgery.
abstract: BACKGROUND
  Although the use of laparoscopy has significantly increased in colorectal procedures, robotic surgery may enable additional cases to be performed using a minimally invasive approach. We separately evaluated the value of laparoscopic and robotic colorectal procedures compared to the open approach.
  
  
  METHODS
  Patients undergoing nonemergent colorectal operations from 2010 to 2013 with National Surgical Quality Improvement Project data were identified. Robotic and laparoscopic procedures were separately matched (1:1) to open cases. Outcomes included 30-day composite morbidity, length of stay, operative time, and inpatient costs. Frequently used intraoperative disposable items were categorized, and significant cost contributors were identified by surgical approach. Statistical differences were determined with Chi-square and Wilcoxon signed-rank tests.
  
  
  RESULTS
  Both laparoscopic (n = 67) and robotic (n = 45) approaches were associated with decreased composite morbidity compared to matched open cases (lap vs. open: 22.4% vs. 49.2%, P < .01; robotic vs. open: 6.7% vs. 33.3%, P < .01). Median length of stay was significantly shorter for both laparoscopic and robotic compared to open surgery (lap vs. open: 5 vs. 7 days, P < .01; robotic vs. open: 5 vs. 7 days, P < .01). Median hospital costs were similar between laparoscopic and open surgery ($13,319 vs. $14,039; P = .80) and robotic and open surgery ($13,778 vs. $13,629; P = .48).
  
  
  CONCLUSIONS
  These findings illustrate the value for both laparoscopic and robotic approaches to colorectal surgery compared to the open approach in terms of short-term outcomes and inpatient costs. Advanced intraoperative disposable items such as cutting staplers and energy devices are important targets for additional cost containment.
authors.affiliation: 1 Department of Surgery, University of Alabama at Birmingham School of Medicine , Birmingham, Alabama.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Hollis
authors.affiliation: 1 Department of Surgery, University of Alabama at Birmingham School of Medicine , Birmingham, Alabama.
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Cannon
authors.affiliation: 1 Department of Surgery, University of Alabama at Birmingham School of Medicine , Birmingham, Alabama.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Singletary
authors.affiliation: 1 Department of Surgery, University of Alabama at Birmingham School of Medicine , Birmingham, Alabama.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Korb
authors.affiliation: 1 Department of Surgery, University of Alabama at Birmingham School of Medicine , Birmingham, Alabama.|2 Department of Surgery, Stanford University School of Medicine , Stanford, California.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Hawn
authors.affiliation: 1 Department of Surgery, University of Alabama at Birmingham School of Medicine , Birmingham, Alabama.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Heslin
mesh_terms: D000368:Aged; D003082:Colectomy / Q000191:economics / Q000379:methods; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery; D013505:Digestive System Surgical Procedures / Q000191:economics / Q000379:methods*; D004239:Diverticulitis, Colonic / Q000601:surgery*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007813:Laparotomy / Q000191:economics / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods*; D014481:United States
keywords: cost-analysis; laparascopic colorectal surgery; robotic colorectal surgery