A comparison of outcomes between laparoscopic and robotic appendectomy among ACS-NSQIP hospitals
Objective: Robotic general surgery remains controversial, with some employing the technology for common laparoscopic procedures such as appendectomies. Very few studies have compared robotic appendectomy (RA) to existing techniques, partly due to the relative scarcity of data. The purpose of this st...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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KeAi Communications Co., Ltd.
2023-06-01
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| Series: | Laparoscopic, Endoscopic and Robotic Surgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S246890092300021X |
| _version_ | 1827919375534915584 |
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| author | Timothy Becker Genaro DeLeon Varun Rao Kevin Y. Pei |
| author_facet | Timothy Becker Genaro DeLeon Varun Rao Kevin Y. Pei |
| author_sort | Timothy Becker |
| collection | DOAJ |
| description | Objective: Robotic general surgery remains controversial, with some employing the technology for common laparoscopic procedures such as appendectomies. Very few studies have compared robotic appendectomy (RA) to existing techniques, partly due to the relative scarcity of data. The purpose of this study was to compare outcomes for RA versus laparoscopic appendectomy (LA). Methods: This retrospective cohort study evaluated procedural specific databases of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) for appendectomy between January 2016 and December 2019 and included all available cases at the time of analysis (June 2021). Demographic and surgical outcomes including composite 30-day complications, specific complications, and length of operation were analyzed using a univariate analysis. Results: In total, there were 52,559 appendectomies in the NSQIP database between 2016 and 2019. Analysis was restricted to those who underwent minimally invasive approaches. In total, 49,850 patients were included in the analysis. Of those, 49,800 patients underwent LA, and 50 patients underwent RA. Participants who underwent RA were older (35.8 ± 4.5 y vs. 23.0 ± 0.2 y, p < 0.01). There was no difference in the total number of comorbidities (92.0% vs. 73.4%, p = 0.32) or the severity of appendicitis (p > 0.90) between RA and LA cases. RA had a longer median operation time (71.0 min vs. 46.0 min, p < 0.01) but a shorter postoperative stay (0.7 d vs. 1.3 d, p < 0.01). There was no difference in the frequency of readmission likely related to procedure (4.0% vs. 3.0%, p = 0.88) or complications (18.0% vs. 23.8%, p = 0.88); however, RA was associated with increased 30-day mortality (2.0% vs. <0.1%, p < 0.01) compared to LA. Conclusion: Our results demonstrated that LA and RA had a similar frequency and profile of complications. Robotic procedures took longer but resulted in shorter postoperative stays. Our study revealed that RA constituted a mere 0.1% of all cases, with only 50% showing pathology consistent with appendicitis, despite 92.2% of LA cases presenting with the condition. Despite our findings of RA offering some benefit, more research is necessary, particularly regarding outcomes and value delivery. |
| first_indexed | 2024-03-13T03:56:55Z |
| format | Article |
| id | doaj.art-61c57c9422ae453383a07f72e104cc5f |
| institution | Directory Open Access Journal |
| issn | 2468-9009 |
| language | English |
| last_indexed | 2024-03-13T03:56:55Z |
| publishDate | 2023-06-01 |
| publisher | KeAi Communications Co., Ltd. |
| record_format | Article |
| series | Laparoscopic, Endoscopic and Robotic Surgery |
| spelling | doaj.art-61c57c9422ae453383a07f72e104cc5f2023-06-22T05:04:35ZengKeAi Communications Co., Ltd.Laparoscopic, Endoscopic and Robotic Surgery2468-90092023-06-01623942A comparison of outcomes between laparoscopic and robotic appendectomy among ACS-NSQIP hospitalsTimothy Becker0Genaro DeLeon1Varun Rao2Kevin Y. Pei3Indiana University School of Medicine, 340 W 10th St, Indianapolis, IN 46202, USA; Corresponding author: Indiana University School of Medicine, 465 Bonterra Blvd, Fort Wayne, IN 46845, USA.Indiana University School of Medicine, 340 W 10th St, Indianapolis, IN 46202, USAIndiana University School of Medicine, 340 W 10th St, Indianapolis, IN 46202, USAParkview Health General Surgery Graduate Medical Education, 2200 Randallia Dr, Fort Wayne, IN 46805, USAObjective: Robotic general surgery remains controversial, with some employing the technology for common laparoscopic procedures such as appendectomies. Very few studies have compared robotic appendectomy (RA) to existing techniques, partly due to the relative scarcity of data. The purpose of this study was to compare outcomes for RA versus laparoscopic appendectomy (LA). Methods: This retrospective cohort study evaluated procedural specific databases of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) for appendectomy between January 2016 and December 2019 and included all available cases at the time of analysis (June 2021). Demographic and surgical outcomes including composite 30-day complications, specific complications, and length of operation were analyzed using a univariate analysis. Results: In total, there were 52,559 appendectomies in the NSQIP database between 2016 and 2019. Analysis was restricted to those who underwent minimally invasive approaches. In total, 49,850 patients were included in the analysis. Of those, 49,800 patients underwent LA, and 50 patients underwent RA. Participants who underwent RA were older (35.8 ± 4.5 y vs. 23.0 ± 0.2 y, p < 0.01). There was no difference in the total number of comorbidities (92.0% vs. 73.4%, p = 0.32) or the severity of appendicitis (p > 0.90) between RA and LA cases. RA had a longer median operation time (71.0 min vs. 46.0 min, p < 0.01) but a shorter postoperative stay (0.7 d vs. 1.3 d, p < 0.01). There was no difference in the frequency of readmission likely related to procedure (4.0% vs. 3.0%, p = 0.88) or complications (18.0% vs. 23.8%, p = 0.88); however, RA was associated with increased 30-day mortality (2.0% vs. <0.1%, p < 0.01) compared to LA. Conclusion: Our results demonstrated that LA and RA had a similar frequency and profile of complications. Robotic procedures took longer but resulted in shorter postoperative stays. Our study revealed that RA constituted a mere 0.1% of all cases, with only 50% showing pathology consistent with appendicitis, despite 92.2% of LA cases presenting with the condition. Despite our findings of RA offering some benefit, more research is necessary, particularly regarding outcomes and value delivery.http://www.sciencedirect.com/science/article/pii/S246890092300021XRoboticsAppendectomyGeneral surgeryNSQIPPostoperative complication |
| spellingShingle | Timothy Becker Genaro DeLeon Varun Rao Kevin Y. Pei A comparison of outcomes between laparoscopic and robotic appendectomy among ACS-NSQIP hospitals Laparoscopic, Endoscopic and Robotic Surgery Robotics Appendectomy General surgery NSQIP Postoperative complication |
| title | A comparison of outcomes between laparoscopic and robotic appendectomy among ACS-NSQIP hospitals |
| title_full | A comparison of outcomes between laparoscopic and robotic appendectomy among ACS-NSQIP hospitals |
| title_fullStr | A comparison of outcomes between laparoscopic and robotic appendectomy among ACS-NSQIP hospitals |
| title_full_unstemmed | A comparison of outcomes between laparoscopic and robotic appendectomy among ACS-NSQIP hospitals |
| title_short | A comparison of outcomes between laparoscopic and robotic appendectomy among ACS-NSQIP hospitals |
| title_sort | comparison of outcomes between laparoscopic and robotic appendectomy among acs nsqip hospitals |
| topic | Robotics Appendectomy General surgery NSQIP Postoperative complication |
| url | http://www.sciencedirect.com/science/article/pii/S246890092300021X |
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