Evaluating the Regional Uptake of Minimally Invasive Colorectal Surgery: a Report from the Surgical Care Outcomes Assessment Program

• Published in: Journal of gastrointestinal surgery Vol. 25; no. 9; pp. 2387 - 2397
• Main Authors: Unruh, Kenley R., Bastawrous, Amir L., Bernier, Greta V., Flum, David R., Kumar, Anjali S., Moonka, Ravi, Thirlby, Richard C., Simianu, Vlad V.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-09-2021; Springer Nature B.V
• Subjects: Abdomen; CAS; Colorectal Surgery; Computer assisted surgery; Gastroenterology; Hospitals; Humans; Laparoscopy; Medicine; Medicine & Public Health; Minimally Invasive Surgical Procedures; Original Article; Outcome Assessment, Health Care; Prospective Studies; Robotic surgery; Robotic Surgical Procedures; Surgery; Colorectal; Laparoscopic; Diverticulitis; Robotic; MIS
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-020-04875-1

Background
Minimally invasive surgery (MIS) for colorectal disease has well-known benefits, but many patients undergo open operations. When choosing an MIS approach, robotic technology may have benefits over traditional laparoscopy and is increasingly used. However, the broad adoption of MIS, and specifically robotics, across colorectal operations has not been well described. Our primary hypothesis is that rates of MIS in colorectal surgery are increasing, with different contributions of robotics to abdominal and pelvic colorectal operations.
Methods
Rates of MIS colorectal operations are described using a prospective cohort of elective colorectal operations at hospitals in the Surgical Care Outcomes Assessment Program (SCOAP) from 2011 to 2018. The main outcome was proportion of cases approached using open, laparoscopic, and robotic surgery. Factors associated with increased use of MIS approaches were described.
Results
Across 21,423 elective colorectal operations, rates for MIS (laparoscopic or robotic surgery) increased from 44% in 2011 to 75% in 2018 (
p
< 0.001). Approaches for abdominal operations (
n
= 12,493) changed from 2 to 11% robotic, 43 to 63% laparoscopic, and 56 to 26% open (
p
< 0.001). Approaches for pelvic operations (
n
= 8930) changed from 3 to 33% robotic, 40 to 42% laparoscopic, and 57 to 24% open(
p
< 0.001). These trends were similar for high-(100 + operations/year) and low-volume hospitals and surgeons.
Conclusions
At SCOAP hospitals, the majority of elective colorectal operations is now performed minimally invasively. The increase in the MIS approach is primarily driven by laparoscopy in abdominal procedures and robotics in pelvic procedures.