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Comparison of outcome and cost among open, laparoscopic, and robotic surgical treatments for rectal cancer: A propensity score matched analysis of nationwide inpatient sample data
Author(s) -
Chen SzuTa,
Wu MengChe,
Hsu TzuChun,
Yen Debra W.,
Chang ChiaNa,
Hsu WanTing,
Wang ChiaChun,
Lee Matthew,
Liu ShingHwa,
Lee ChienChang
Publication year - 2018
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24867
Subject(s) - medicine , propensity score matching , colorectal cancer , laparoscopic surgery , surgery , robotic surgery , healthcare cost and utilization project , retrospective cohort study , open surgery , cohort , cancer , cohort study , laparoscopy , health care , economics , economic growth
Background Population‐based studies evaluating outcomes of different approaches for rectal cancer are scarce. Methods We conducted a retrospective cohort study using the Nationwide Inpatient Sample database between 2008 and 2012. We compared the outcomes and costs among rectal cancer patients undergoing robotic, laparoscopic, or open surgeries using propensity scores for adjusted and matched analysis. Results We identified 194 957 rectal cancer patients. Over the 5‐year period, the annual admission number decreased by 13.9%, the in‐hospital mortality rate decreased by 32.2%, while the total hospitalization cost increased by 13.6%. Compared with laparoscopic surgery, robotic surgery had significantly lower length of stay (LOS) (OR 0.69, 95%CI 0.57‐0.84), comparable wound complications (OR 1.08, 95%CI 0.70‐1.65) and higher cost (OR 1.42, 95%CI 1.13‐1.79), while open surgery had significantly longer LOS (OR 1.38, 95%CI 1.19‐1.59), more wound complications (OR 1.49, 95%CI 1.08‐1.79), and comparable cost (OR 0.92, 95%CI 0.79‐1.07). There were no difference in in‐hospital mortality among three approaches. Conclusions Laparoscopic surgery was associated with better outcomes than open surgery. Robotic surgery was associated with higher cost, but no advantage over laparoscopic surgery in terms of mortality and complications. Studies on cost‐effectiveness of robotic surgery may be warranted.