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Comparative Study
. 2014 Feb;149(2):177-84.
doi: 10.1001/jamasurg.2013.3660.

Is minimally invasive colon resection better than traditional approaches?: First comprehensive national examination with propensity score matching

Yen-Yi Juo  1 , Omar Hyder  1 , Adil H Haider  1 , Melissa Camp  1 , Anne Lidor  1 , Nita Ahuja  2
Affiliations
Comparative Study

Is minimally invasive colon resection better than traditional approaches?: First comprehensive national examination with propensity score matching

Yen-Yi Juo et al. JAMA Surg. 2014 Feb.

Abstract

Importance: 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).

Design, setting, and participants: 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 and relevance: 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.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure
Figure. Propensity Score–Matched Comparison Between Laparoscopic Colectomy and Open Colectomy
Statistically significant differences were observed in mortality, complication, ostomy, and routine discharge rates between laparoscopic colectomy and open colectomy.
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