Objective:

To identify factors influencing the type of surgical approach and evaluate disparities in access and outcomes of colectomy and proctectomy from 2013–2020 using a national database.

Approach:

• Data Source: Utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify patients aged 18 and older who underwent colectomy and/or proctectomy from 2013–2020.
• Patient Selection: Included patients who underwent open, laparoscopic, or robot-assisted surgery, excluding emergency and endoscopic procedures.
• Outcomes: Primary outcome was the frequency of robotic colorectal surgery; secondary outcomes included postoperative complications and mortality.
• Statistical Analysis: Performed univariate and multivariate analyses to identify associations between demographic/clinical factors and surgical approaches.

Key Findings:

• Robotic surgery adoption in colorectal surgery has increased since the early 2000s but remains concentrated in academic teaching hospitals.
• Racial disparities exist in access to robotic surgery, with Black patients less frequently offered minimally invasive surgery compared to White patients.
• The study identified a need for further investigation into whether robotic surgery utilization is increasing equally across different patient populations.

Interpretation:

The findings highlight significant inequities in access to robotic surgical techniques, particularly affecting racial and socioeconomic groups.

Limitations:

• The study did not include data on the indication for surgery, relying instead on diagnosis groups as a surrogate.
• Potential biases in the NSQIP database may affect the generalizability of the findings.

Conclusion:

Further research is needed into the trends of robotic surgery adoption across diverse patient demographics.