EP912 - Comparison of Postoperative Outcomes in Robotic Versus Laparoscopic Hartmann’s Reversal: A NSQIP Analysis

Purpose/Background: Hartmann's procedure reversal is a technically difficult procedure associated with significant postoperative morbidity and mortality. Previous studies have showed that a minimally invasive approach (either robotic or laparoscopic) to a Hartmann's reversal have increased in frequency over the past several years. We aim to compare postoperative complications for robotic versus laparoscopic Hartmann's reversal.

Methods/Interventions: We utilized the 2022-2023 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify all patients ≥18 years old who underwent a laparoscopic or robotic Hartmann's reversal procedure. We developed a multivariable regression model to identify postoperative outcomes in the robotic versus laparoscopic group. The primary outcome was defined as a composite of postoperative complications including stroke, myocardial infarction, wound infection, respiratory and renal failure. Secondary outcomes included unplanned conversion to open, return to the operating room, operative duration and total length of stay.

Results/Outcomes: We included a total of 5,553 patients who underwent a minimally invasive Hartmann's reversal from 2022-2023. 1,146 (21%) underwent a robotic procedure while 4,407 (79%) underwent a laparoscopic procedure. The mean age was 58 (p=0.819) for both groups. The robot group had a higher mean BMI (29.4 vs 28.8, p=0.012) while there were more smokers in the laparoscopic group (20.9% vs 18.1%, p=0.035). Those who underwent laparoscopic surgery had 26% higher risk of experiencing the composite of postoperative complications (OR 1.26 (1.03-1.55), p=0.027) than those who had a robotic approach. Patient factors that were associated with increased risk of postoperative complications included: BMI of 35-39.9 (OR 1.66 (1.16-2.36), p=0.005), ASA class 3 (OR 4.91 (1.15-20.89), p=0.031) and smokers (OR 1.41 (1.10-1.80), p=0.006). Mean operative time was longer in the robot group (252 minutes vs 214 minutes, p< 0.001) while mean length of stay was shorter in the robot group (4.3 days vs 5.3 days, p< 0.001). Conversion and reoperation rates were similar between the approaches.

Conclusion/Discussion: In this analysis of minimally invasive Hartmann's reversals using the NSQIP database, the robotic approach was associated with a lower rate of postoperative complications compared to the laparoscopic approach, despite longer operative times. Additionally, robotic procedures were associated with a shorter hospital length of stay. While this study cannot control for surgeon experience and biases for operative approach, in this cohort of patients, a robotic Hartmann's reversal was associated with improved 30-day postoperative outcomes relative to the laparoscopic approach.

Table 1
Multivariable regression model for primary outcome and identification of associated variables