OBJECTIVES:  There are limited studies compare the outcomes and costs of robotic, laparoscopic, and open surgeries in a nationally representative population database. Our study aims to compare the inpatient outcomes among colon cancer patients undergoing these three types of surgeries. METHODS:  A retrospective analysis of the National Inpatient Sample database from 2008 to 2012 was performed. We identified the robotic, laparoscopic, and open procedures by International Classification of Diseases, 9th Revision (ICD-9) procedure codes and grouped them into categories by procedure type. We compared the in-hospital mortalities, complications, length of stays, and costs for patients undergoing open, laparoscopic or robotic surgeries. The outcomes and costs of the different surgical modalities were adjusted using propensity score. RESULTS: Of the 499,724 weighted number of colorectal surgeries performed during the study period, 371,463 (74.3%) were open surgeries, 120,615 (24.1%) were laparoscopic surgeries, and 7,646 (1.53%)
were robotic surgeries. In comparison with laparoscopic surgeries after propensity score adjustment, open surgeries was associated with 2.6 fold increase in risk of in-hospital mortality, 17% increase in risk of wound complications, 63% increase in general medical complications, 58% increase in risk of general surgical complications, 2.5 fold increase in risk in longer hospital stay, and higher total cost ($ 16,901 vs $ 13,723) than laparoscopic surgery.
The outcomes of laparoscopic and robotic surgery are generally comparable after propensity score adjustment, except for in-hospital mortality and costs. Patients undergoing laparoscopic surgeries have 3.6 fold increase in risk of in-hospital mortality, and lower cost ($13,134 vs $19,187) than robotic surgery. CONCLUSIONS:  Minimally invasive robotic and laparoscopic colorectal cancer surgeries have fewer complications, lower in-patient mortality, and shorter hospital stays. Their use in colorectal cancer surgery should increase with efforts to improve the outcome. Additional studies are needed to better delineate the comparative and cost-effectiveness of robotic surgery relative to laparoscopic surgery.