title: A comparison of trends in operative approach and postoperative outcomes for colorectal cancer surgery.
abstract: Data-assessing trends and perioperative outcomes relative to surgical approach for colorectal cancer (CRC) surgery are lacking. We report national trends of CRC surgery and compare postoperative outcomes by surgical approach.
  
  
  
  A total of 261,886 patients undergoing surgery for CRC were identified using the Nationwide Inpatient Sample from 2009 to 2012. Trends in surgical approach were assessed using the Cochrane-Armitage test of trends. Multivariable logistic and linear regression analyses were performed to compare length of stay (LOS), postoperative complications, and cost by surgical approach.
  
  
  
  At the time of surgery, 57.5% underwent an open procedure, whereas 42.4% underwent either a laparoscopic (39.9%) or robotic (2.5%) colorectal surgery. The use of minimally invasive surgery increased over time (2009 versus 2012: 37.3% versus 46.8%; P < 0.001). Postoperative morbidity was 15.9% and was higher after open surgery (open versus laparoscopic versus robotic: 18.4% versus 12.4% versus 13.3%; P < 0.001). Patients who underwent a minimally invasive surgery had shorter LOS (laparoscopic: OR, 0.55, 95% CI, 0.52-0.58; robotic: OR, 0.58; 95% CI, 0.49-0.69; both P < 0.001). Robotic surgery was consistently associated with the highest mean costs followed by laparoscopic and open surgery (P < 0.001).
  
  
  
  Patients undergoing minimally invasive colorectal surgery had a lower postoperative morbidity and shorter LOS compared with patients undergoing open colorectal surgery.
authors.affiliation: Department of Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland. Electronic address: jaddae1@jhmi.edu.
authors.forename: Jamin K
authors.initials: JK
authors.lastname: Addae
authors.affiliation: Department of Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland.
authors.forename: Faiz
authors.initials: F
authors.lastname: Gani
authors.affiliation: Department of Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland.
authors.forename: Sandy Y
authors.initials: SY
authors.lastname: Fang
authors.affiliation: Department of Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Wick
authors.affiliation: Department of Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland.
authors.forename: Azah A
authors.initials: AA
authors.lastname: Althumairi
authors.affiliation: Department of Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Efron
authors.affiliation: Department of Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Canner
authors.affiliation: Department of Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland.
authors.forename: David M
authors.initials: DM
authors.lastname: Euhus
authors.affiliation: Department of Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: eschnei1@jhmi.edu.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D003430:Cross-Sectional Studies; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012371:Robotics; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Colorectal cancer; Costs; Length of stay; Minimally invasive surgery; Morbidity; Temporal trends