Improved Morbidity, Mortality, and Cost with Minimally Invasive Colon Resection Compared to Open Surgery

Background and Objectives: Despite the growth of minimally invasive surgery (MIS) in many specialties, open colon surgery is still routinely performed. The purpose of this study was to compare outcomes and costs between open colon and minimally invasive colon resections. Methods: We analyzed outcomes between January 1, 2016 and December31, 2018 using the Vizient (R) clinical database. Demographics, hospital length of stay, readmissions, complications, mortality, and costs were compared between patients undergoing elective open and minimally invasive colon resections. For bivariate analysis, Wilcoxon rank-sum test was used for continuous variables and chi(2) test was used for categorical variables. Multiple Logistic and Quintile regression were used for multivariable analyses. Results: A total of 88,405 elective colon resections (open: 56,599; minimally invasive: 31,806) were reviewed. A significantly larger proportion of patients undergoing minimally invasive surgery were obese (body mass index > 30) compared to those undergoing open surgery (71.4% vs. 59.6%; p<0.0001). As compared to minimally invasive colectomy, open colectomy patients had: a longer median length of stay [median (range): 7 (4-13) days vs. 4 (3 - 6) days, p<0.0001], higher 30-day readmission rate [n = 8557 (15.1%) vs. 2815 (8.9%), p<0.0001], higher mortality [n = 2590 (4.4%) vs. 107 (0.34%), p<0.0001], and a higher total direct cost [median (range): $13,582 (9041-23,094) vs. $9013 (6748 - 12,649), p<0.0001]. Multivariable models confirmed these findings. Conclusion: Minimally invasive colon surgery has clear benefits in terms of length of stay, readmission rate, mortality and cost, and the routine use of open colon resection should be revaluated.