Evaluating the Regional Uptake of Minimally Invasive Colorectal Surgery: a Report from the Surgical Care Outcomes Assess
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ORIGINAL ARTICLE
Evaluating the Regional Uptake of Minimally Invasive Colorectal Surgery: a Report from the Surgical Care Outcomes Assessment Program Kenley R. Unruh 1 & Amir L. Bastawrous 2 & Greta V. Bernier 3 & David R. Flum 4 & Anjali S. Kumar 5 & Ravi Moonka 1 & Richard C. Thirlby 1 & Vlad V. Simianu 1 Received: 4 June 2020 / Accepted: 10 November 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract 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. Keywords Robotic . Laparoscopic . MIS . Colorectal . Diverticulitis
Introduction
* Vlad V. Simianu [email protected] 1
Department of Surgery, Virginia Mason Medical Center, 1100 9th Ave, C6-GS, Seattle, WA 98101, USA
2
Swedish Cancer Institute, Swedish Medical Center, Seattle, WA, USA
3
Colon and Rectal Surgery Clinic, University of Washington Medicine-Valley Medical Center, Renton, WA, USA
4
Department of Surgery, University of Washington, Seattle, WA, USA
5
Department of Medical Education and Clinical Sciences, Washington State University, Spokane, WA, USA
The benefits of minimally invasive surgery (MIS) within colorectal surgery have been demonstrated by multiple large, multi-center studies showing lower post-operative pain, decreased length of stay (LOS), fewer surgical site infections, and decreased overall hospital costs.1–4 These same studies have also shown equivalent oncologic outcomes for an MIS approach
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