ORIGINAL ARTICLE Comparison of Risk Factors for Unplanned Conversion from Laparoscopic and Robotic to Open Colorectal Surgery Using the Michigan Surgical Quality Collaborative (MSQC) Database Anuradha R. Bhama 1 & Abdullah M. Wafa 1 & Jane Ferraro 1 & Stacey D. Collins 2 & Andrew J. Mullard 2 & James F. Vandewarker 1 & Greta Krapohl 2 & John C. Byrn 2 & Robert K. Cleary 1 Received: 12 December 2015 /Accepted: 21 January 2016 # 2016 The Society for Surgery of the Alimentary Tract Abstract Robotic colorectal surgery has been shown to have lower rates of unplanned conversion to open surgery when compared to laparoscopic surgery. Risk factors associated with conversion from robotic to open colectomy and comparisons of the risk factors between robotic and laparoscopic approaches have not been previously reported. Patients who underwent elective laparoscopic and robotic colorectal surgeries between July 1, 2012 and April 28, 2015, were identified in the Michigan Surgical Quality Collaborative registry. Candidate covariates were identified, and hierarchical logistic regression models were used to identify risk factors for conversion. There were 4796 cases that met study inclusion criteria. Conversion was required in 18.2 % of laparoscopic and 7.7 % of robotic cases (p < 0.0001). Risk factors for conversion in the laparoscopic group included the following: moderate/severe adhe- sions, obesity, colorectal cancer, hypertension, rectal operations, urgent priority, and tobacco use. Risk factors for conversion in the robotic group included the following: severe adhesions, bleeding disorder, presence of cancer, cirrhosis, and use of statins. Higher surgeon volume was protective in both groups. Conversion rates are lower for robotic than for laparoscopic colorectal surgery with fewer predictors of conversion. Recognition of factors predicting conversion may allow surgeons to choose an operative approach that optimizes the benefits of the available technologies. Keywords Robotic surgical procedures . Colorectal surgery . Minimally invasive surgery . Conversion to open surgery Introduction Several studies have demonstrated that minimally inva- sive colorectal operations are safe and oncologically sound. 1–5 Conversion from a laparoscopic to an open procedure has been shown to have worse outcomes with respect to ileus, septic complications, and oncologic margins when compared to those operations that do not require conversion. 6–8 Previous studies have demonstrated that high body surface area, high body mass index, recent weight loss, smoking, ASA class, tobacco use, chronic obstructive pulmonary disease, ascites, and recent treatment with chemotherapy are all significant risk factors for conver- sion to an open procedure. 9–11 Tumor-specific factors in those with cancer have also been found to influence the need to convert to an open procedure. 12 These studies Previous communication: Presented as a poster presentation at the American Society of Colon and Rectal Surgeons Annual Scientific Meeting, Boston, MA, June 5/30/2015-6/3/2015 * Anuradha R. Bhama anuradha.bhama@gmail.com 1 Department of Surgery, Division of Colon and Rectal Surgery, St. Joseph Mercy Health System—Ann Arbor, 5325 Elliott Dr, MHVI Suite #104, Ann Arbor, MI 48106, USA 2 Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor, MI 48104, USA J Gastrointest Surg DOI 10.1007/s11605-016-3090-6