Outcomes Following Robotic Surgery for Complicated and Uncomplicated Diverticulitis

摘要

Background Laparoscopic colectomy is standard for uncomplicated diverticulitis (UD) but has higher conversion and morbidity rates in complicated diverticulitis (CD). Robotic colectomy (RC) is increasingly used for both UD and CD. This study compared outcomes of RC for CD and UD and evaluated factors contributing to adverse outcomes. Methods Using 2014-2021 NSQIP data, we identified patients with CD or UD who underwent RC. The primary endpoint was textbook outcome (TO), defined as absence of prolonged length of stay (LOS), major morbidity, readmission, anastomotic leak, or mortality within 30 days. Regression analyses were used to assess outcomes and associated factors. Results Among 6829 patients, 4604 (67.4%) had UD, and 2225 (32.6%) had CD. Complicated diverticulitis patients were more often male (50.3% vs 41.0%; P < 0.001) and had smoking history (21.0% vs 16.1%; P < .001), preoperative sepsis (3.1% vs 0.8%; P < .001), and delayed surgery >1 day after admission (8.8% vs 1.9%; P < .001). Textbook outcome was achieved in 48.5% of CD vs 62.9% of UD patients ( P < .001), and major morbidity occurred in 12.5% vs 5.4% ( P < .001). On regression analyses, CD patients had lower odds of achieving TO (OR 0.754 [95% CI 0.673-0.846]) and higher odds of major morbidity (1.949 [1.610-2.360]), conversion (1.577 [1.262-1.972]), prolonged LOS (1.280 [1.137-1.440]), iatrogenic complication (2.134 [1.561-2.918]), postoperative sepsis (2.653 [2.020-3.486]), and organ/space infection (1.751 [1.374-2.232]). Factors associated with TO achievement were identified separately in UD and CD cohorts. Conclusion Robotic colectomy is a safe and feasible option for both UD and CD, with anticipated variations in complication rates reflecting differences in disease complexity.