Abstract
Background
Robotic-assisted surgery is increasingly available in rural Michigan, but outcomes in these populations remain unclear. National data suggest robotic colectomies are associated with improved outcomes compared with open procedures, but evidence for rural patients is limited. This study compared postoperative outcomes of open, laparoscopic, and robotic right colectomies among rural and urban Michigan residents.
Methods
The HCUP State Inpatient Sample (2016-2018) identified adults undergoing right colectomy. Rural and urban residence was classified using Urban Influence Codes (UIC); rural residence was defined as codes 3-12. Complications included prolonged ileus, pneumonia, surgical site infection, abscess, septicemia, hemorrhage/hematoma, urinary tract infection, in-hospital death, and length of stay ≥5 days. ICD-10 codes identified surgical approach. Logistic regression estimated adjusted odds ratios (aORs), controlling for demographic and clinical covariates.
Results
Among rural residents, minimally invasive approaches were associated with lower odds of complications than open surgery, with robotic procedures showing the lowest odds. Urban residents undergoing robotic colectomies experienced greater reductions in odds of pneumonia and urinary tract infections than rural residents.
Discussion
Minimally invasive right colectomy was associated with lower odds of complications compared with open surgery. Robotic techniques showed the most favorable outcomes, though benefits appeared greater among urban residents. These disparities may reflect institutional experience, infrastructure, or access to robotic platforms. Given the limitations of administrative data and observational design, results should be interpreted as associations rather than causation. Further studies incorporating hospital- and surgeon-level data and post-discharge outcomes are needed to clarify rural-urban differences and guide equitable surgical care.
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