Trends in utilization and inpatient outcomes of minimally invasive colectomy for colorectal cancer in the United States, 2018–2023.

Abstract

e23195 Background: Use of minimally invasive surgery (MIS) for colorectal cancer (CRC) resection has expanded rapidly, with increasing adoption of robotic platforms. Contemporary national data describing inpatient utilization trends, outcomes, and costs across surgical approaches remain limited. Methods: A retrospective, serial cross-sectional analysis was performed using the 2018–2023 Healthcare Cost and Utilization Project National Inpatient Sample. Adult hospitalizations with a principal diagnosis of CRC undergoing colorectal resection 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, a composite of in-hospital complications, length of stay (LOS), and hospitalization cost estimated using cost-to-charge ratios. National estimates accounted for survey weighting, clustering, and stratification. Survey-weighted regression models adjusted for demographics, payer, income quartile, elective status, APR-DRG severity and risk of mortality, calendar year, and hospital characteristics. Sensitivity analyses were performed in elective-only and non-metastatic cohorts. Results: From 2018–2023, an estimated 348,390 CRC resection hospitalizations were identified nationally. Robotic-assisted surgery increased from 16.5% in 2018 to 33.3% in 2023, while open surgery declined from 61.9% to 47.7% (design-based p < 0.001). Unadjusted in-hospital mortality was highest following open surgery (2.58%) compared with laparoscopic (0.70%) and robotic-assisted (0.65%) approaches. Mean LOS was 9.76 days for open colectomy versus 6.35 days for laparoscopic and 5.76 days for robotic-assisted colectomy; mean costs were $37,744, $27,468, and $35,558, respectively. In adjusted analyses using laparoscopy as the reference, open surgery was associated with higher odds of in-hospital complications (OR 1.25, 95% CI 1.09–1.44) and longer LOS (+1.58 days), while robotic-assisted surgery was associated with longer LOS (+0.63 days) and higher costs, including approximately 28% higher adjusted costs compared with laparoscopy. Sensitivity analyses demonstrated similar patterns across elective-only and non-metastatic subgroups. Conclusions: Between 2018 and 2023, inpatient CRC resections in the United States demonstrated rapid growth in robotic-assisted surgery with a concurrent decline in open surgery. Across analyses, open colectomy was associated with higher mortality, complications, LOS, and costs compared with MIS approaches, while robotic-assisted colectomy was associated with higher inpatient costs relative to laparoscopy. These findings provide contemporary national benchmarking data on surgical utilization patterns, inpatient outcomes, and costs for CRC resection.