Surgical trends and outcomes of open, laparoscopic, and robotic colostomy reversal for benign disease

• Published in: Surgery 2024-11, Vol.176 (5), p.1366-1373
• Main Authors: Katsura, Morihiro, Ashbrook, Matthew, Ikenoue, Tatsuyoshi, Takahashi, Kyosuke, Ito, Masaki A., Martin, Matthew J., Inaba, Kenji, Matsushima, Kazuhide
• Format: Article
• Language: English
• Subjects: Adult; Aged; Colonic Diseases - surgery; Colostomy - adverse effects; Colostomy - methods; Colostomy - statistics & numerical data; Female; Humans; Laparoscopy - adverse effects; Laparoscopy - methods; Laparoscopy - statistics & numerical data; Laparoscopy - trends; Length of Stay - statistics & numerical data; Male; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods; Robotic Surgical Procedures - statistics & numerical data; Robotic Surgical Procedures - trends; Treatment Outcome; United States - epidemiology
• ISSN: 0039-6060; 1532-7361; 1532-7361
• DOI: 10.1016/j.surg.2024.07.029

Despite the increasing use of minimally invasive surgeries, the outcome benefits of adopting minimally invasive surgery for colostomy reversal remain unclear. We aimed to analyze nationwide trends in the use of minimally invasive surgery for colostomy reversal and compare patient outcomes between different surgical approaches. The National Inpatient Sample was queried for patients who underwent colostomy reversal for benign disease from 2015 to 2021. National trends in the use of minimally invasive surgery for colostomy reversal were analyzed by Cochran-Armitage tests. Multivariable linear and logistic regressions accounting for hospital sample weights were developed to examine the association between operative approach (open, laparoscopic, and robotic) and patient outcomes, including hospital complications, length of stay, and hospital charges. A total of 23,260 patients underwent colostomy reversal: 18,880 (81.2%) open, 3,245 (14.0%) laparoscopic, and 1,135 (4.9%) robotic surgery. From 2015 to 2021, the proportion of robotic approaches increased >5-fold (range 2.1–12.5%; Ptrend < .001), whereas the increase in laparoscopic approaches was not significant (range 11.5–16.2%; Ptrend = .34). Multivariable analysis showed that the laparoscopic approach was associated with a lower incidence of pulmonary complications (adjusted odds ratio, 0.49; 95% confidence interval, 0.28–0.87), surgical-site infection (odds ratio, 0.37; 95% CI, 0.19–0.72), peritonitis/abdominal abscess (odds ratio, 0.45; 95% confidence interval, 0.26–0.78), and paralytic ileus (odds ratio, 0.67; 95% confidence interval, 0.48–0.92). The robotic approach was associated with a lower incidence of paralytic ileus (odds ratio, 0.58; 95% confidence interval, 0.33–0.99). Laparoscopic and robotic approaches were associated with 22.9% and 29.9% shorter length of stay, respectively. The robotic approach was associated with 33.0% greater hospital charge. This study observed a significant trend toward the increased use of robotics in colostomy reversal and potential clinical benefits with minimally invasive surgery. Robotic colostomy reversal, along with laparoscopic approach, may provide better postoperative recovery compared with the open approach; however, the utility of robotic surgeries needs to be reevaluated in the future, given the limited clinical benefits despite greater hospital charges.