Non-elective colectomy for diverticulitis in the U.S.: a retrospective comparison of robotic, laparoscopic, and open...

Minimally invasive techniques are increasingly used in emergency surgery, including in acute diverticulitis. While studies have shown that laparoscopic colectomy in the emergent/urgent management of acute diverticulitis has better outcomes compared to open surgery, data on robotic surgery outcomes remain limited. This study aims to compare the outcomes of patients with acute diverticulitis requiring non-elective operations across open, laparoscopic, and robotic surgical approaches.

A retrospective analysis from the Premier healthcare database (2019-2023) was conducted, including patients undergoing non-elective left or sigmoid colectomy for acute diverticulitis. Emergency surgery was defined as colectomy performed within 48 h from admission; urgent surgery was defined as colectomy performed between 2 and 12 days after admission. Our primary outcome was conversion to open surgery. Secondary outcomes included anastomotic leak, stoma creation during the index operation, stoma creation within 30 days from surgery, hospital length of stay, readmission and reoperation rates. Propensity Score Matching (PSM) 1:1 was applied to adjust for patient demographics, comorbidities, disease severity and hospital/surgeon characteristics.

A total of 28,456 patients were included in the analysis [17,934 (63%) emergent; 10,522 (37%) urgent surgery]. Open surgery was the predominant modality (77.6% emergent; 63.2% urgent) with robotic surgery use increasing threefold during the study period. On univariate analysis, emergent surgery was more common in patients requiring ICU admission and patients with associated peritoneal abscess. Robotic surgery was more common in younger patients, with fewer comorbidities, as well as in urban mid-size institutions. After PSM, robotic surgery was associated with lower rates of conversion to open surgery compared to laparoscopic surgery (emergent setting: 10.2% vs 22.6%, p-value < 0.001; urgent setting: 13% vs 27.8%, p-value < 0.001). Patients undergoing robotic surgery also had lower rates of stoma creation at index operation, and shorter hospital stay compared to laparoscopic surgery (emergent and urgent operations). In emergent colectomies only, robotic surgery was associated with a 29% relative-risk reduction of anastomotic leaks [laparoscopic 9.6% vs. 6.8%, p-value = 0.029].

The robotic platform is expanding rapidly within the emergency general surgery patient population. Robotic colectomy for non-elective diverticulitis is a safe and feasible option with improved post-operative outcomes when compared to laparoscopic surgery.