Association of Robotic Surgery with Early Discharge, Readmission, and Complications in Elective Colectomy: An Analysis of NSQIP Data from 2012-2021

Abstract

Background: Early discharge (ED) after colectomy has become a target outcome for multiple reasons, but the factors associated with ED are not well characterized. This study investigated the factors associated with ED and evaluated the impact of ED on overall outcome. Methods: Data from ACS-NSQIP were used to identify patients who underwent non-emergent colectomy from 2012 to 2021. ED was defined as length of stay ≤2 days. Unpaired t-tests, chi-square tests and adjusted multivariate logistic regression modeling were used to estimate associated factors for ED. Bounceback readmission was defined as readmission within 7 days of discharge. Results: In this cohort of 282,490 patients, 43,137 (15.3%) met the criteria for ED. Robotic colectomy (OR 14.35; 95%CI [13.63-15.12]) was more strongly associated with ED than any other patient characteristic, including laparoscopic colectomy (6.82 [6.51-7.14], ref open colectomy). ED vs. non-ED patients had lower rates of 30-day (5.84 vs. 10.37%, P<0.01) and bounceback (3.56 vs. 5.75%, P<0.01) readmissions, overall complications (5.65 vs. 18.63%, P<0.01) and post-discharge complications (4.21 vs. 7.49%, P<0.01). Conclusions: Robotic surgery was the variable most strongly associated with ED, and had twice the odds of ED compared to laparoscopic colectomy. Patients who had ED after robotic surgery had lower rates of complications and readmission compared to non-ED patients.