Inpatient outcomes and cost utilization by surgical approach for elective non-metastatic colon cancer resection in the United States, 2018–2023.

Abstract

e23189 Background: Minimally invasive colectomy is commonly used for colon cancer resection, with increasing adoption of robotic platforms. Contemporary national data comparing inpatient outcomes and costs across open, laparoscopic, and robotic approaches in elective non-metastatic colon cancer are limited. Methods: A retrospective, serial cross-sectional analysis was performed using the 2018–2023 Healthcare Cost and Utilization Project National Inpatient Sample. Adult hospitalizations undergoing elective colectomy for non-metastatic colon cancer were identified using ICD-10-CM and ICD-10-PCS codes. Surgical approach was classified as open, laparoscopic, or robotic-assisted. Outcomes included in-hospital mortality, postoperative complications, length of stay (LOS), and hospitalization cost estimated using cost-to-charge ratios. National estimates accounted for survey weighting, clustering, and stratification. Multivariable survey-weighted regression models compared outcomes across approaches, adjusting for age, sex, race and ethnicity, payer type, income quartile, hospital characteristics, calendar year, and severity of illness. Temporal trends in minimally invasive surgery utilization were evaluated using survey-weighted logistic regression. Results: An estimated 225,690 elective colectomy hospitalizations for non-metastatic colon cancer were identified nationally. Utilization of minimally invasive surgery increased over time (odds ratio per year 1.18, 95% CI 1.16–1.20), driven primarily by growth in robotic surgery. Unadjusted in-hospital mortality was highest for open colectomy (1.13%) compared with laparoscopic (0.44%) and robotic (0.49%) approaches. Postoperative complications occurred in 26.5% of open, 16.8% of laparoscopic, and 15.4% of robotic hospitalizations. Mean LOS was 5.9 days for open colectomy, 4.1 days for laparoscopic, and 3.8 days for robotic approaches. In adjusted analyses, laparoscopic (adjusted OR 0.47, 95% CI 0.35–0.65) and robotic colectomy (adjusted OR 0.51, 95% CI 0.36–0.72) were associated with lower odds of in-hospital mortality compared with open surgery. Adjusted LOS was shorter for laparoscopic (−0.29 days) and robotic (−0.38 days) approaches relative to open colectomy (p < 0.001 for both). Mean hospitalization costs were $21,599 for laparoscopic, $24,682 for open, and $27,588 for robotic colectomy. Conclusions: In this national inpatient analysis of elective non-metastatic colon cancer resections, minimally invasive surgical approaches were associated with lower in-hospital mortality and shorter length of stay compared with open colectomy, with higher costs observed for robotic-assisted surgery. These findings provide contemporary benchmarking data on utilization patterns, short-term outcomes, and inpatient costs across colectomy approaches.