EP464 - From Innovation to Maturity: Nine-Year Trends in Colectomies with Robotic Adoption, Outcomes, and Cost Efficiency Across a Multi-Hospital System (2017–2025)

Purpose/Background: Robotic colectomy offers precision and ergonomic advantages but has been criticized for higher per-case cost. Whether mature robotic adoption improves system-level value remains unclear. We evaluated nine years of colectomy data across an integrated health system to assess the relationship between robotic diffusion, outcomes, and cost efficiency, compared with laparoscopic and open surgery.

Methods/Interventions: This study analyzed 9,627 colectomy procedures from 2017-2025 across 31 hospitals, involving 193 surgeons. It compared robotic (reference), laparoscopic, and open surgeries. Covariates included ASA class, BMI, CMI, admission type, stoma creation, and surgeon fellowship training (CRC-trained vs non-trained). Outcomes were LOS, 30-day readmission, reintervention, conversion to open and estimated costs. Models used negative binomial and mixed-effects logistic regression with random intercepts for surgeon and hospital.

Results/Outcomes: Robotic colectomy utilization increased significantly from 15% in 2017 to 44% in 2025 (p < 0.001), whereas the use of open colectomy declined from 32% to 22%. Case complexity enhanced over this period, with the proportion of ASA ≥3 patients rising from 62% to 71%. The length of stay (LOS) decreased from 4.8 to 3.9 days (p < 0.001), and the readmission rate reduced from 10.7% to 7.3% (p = 0.02). Robotic surgery demonstrated a lower conversion rate to open procedures compared with laparoscopic approaches (109/2,759 [4.0%] vs. 727/3,080 [23.6%], p < 0.001). Although robotic surgery incurs higher immediate operative costs (+$1,700 to $1,800; p < 0.001), the total episode costs, accounting for LOS and readmissions, are estimated to be lower by $1,100 to $2,100 relative to laparoscopic or open cases. Moreover, fellowship training in colorectal surgery did not significantly impact patient outcomes.

Conclusion/Discussion: Despite higher per-case OR cost, robotic colectomy is associated with shorter LOS, fewer readmissions, lower conversion rates, and decreased estimated total episode cost. Over a nine-year period, outcomes have plateaued, indicating a transition from innovation to maturity. Future advancements depend on optimizing pathways and establishing surgeon standardization.