Edwin Acevedo Jr, MD1, Michael Mazzei, MD, MPH, MS1, Huaqing Zhao, PhD, MS2, Xiaoning Lu, MS2, Michael A Edwards, MD, FACS, FASMBS2. 1Temple University Hospital, 2Lewis Katz School of Medicine at Temple University
Introduction: Revisional bariatric surgery is being increasingly performed and is associated with higher operative risks. Optimal technique to minimize complications remains controversial. Here, we report a retrospective review of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant User Files (PUF) database, comparing outcomes between for revision/conversion bariatric surgery using conventional laparoscopic (LBS) and robotic-assisted (RBS) approaches.
Methods: Revisional/conversion cases were identified in the 2015 and 2016 MBSAQIP PUF database. Selected cases were characterized into two groups (RBS; LBS). Case-controlled matching (1:1) was performed of the RBS and LBS cohorts. Cases and controls were match by demographics (age, gender, race, BMI) and preoperative comorbidities. Outcomes measures included operative length (OL), length of stay (HLOS), 30-day outcomes, and complications.
Results: 26,404 revision/conversion cases were identified (93.3% LBS, 6.7% RBS). 85.6% were female and 67% white. Mean age and BMI were 48 years and 40.9kg/m2. 1,144 matched RBS and LBS cases and controls were identified and outcomes compared (Table 1). 30-day follow-up was less for LBS (93.2% vs 95.5%, p=0.024). RBS was associated with significanlty longer operative times (p<0.0001) and hospital length of stay (p= 0.0002). Unplanned ICU admission (1.31% vs 0.52%, p=0.049), aggregate bleeding (p=0.069) and aggregate leak (p=0.087) were higher in RBS. 30-day mortality, reoperation, readmission, intervention and all other complications were similar.
Conclusion: In this matched cohort analysis of revision/conversion bariatric surgery, robotic-assisted and conventional laparoscopic approaches seem to be equally safe, but RBS is likely less cost-effective due to longer operative times and hospital length of stay.
| Surgical Approach | |||
|
Conventional Laparoscopic [n=1,144] |
Robotic-Assisted [n=1,144] | p vaule | |
| OL_Minutes (mean±SD) | 121.71±67.45 | 177.42±79.40 | <0.0001* |
| HOS_Days (mean±SD) | 2.19±3.09 | 2.38±3.07 | 0.0002* |
| Outcome, No. (%) | |||
| Conversion Rate | 11 (0.96) | 13 (1.14) | 0.68 |
| 30-day Unplanned ICU Admission | 6 (0.52) | 15 (1.31) | 0.049* |
| 30-day Reoperation | 32 (2.8) | 42 (3.67) | 0.24 |
| 30-day Mortality | 2 (0.17) | 3 (0.26 | 0.65 |
| Death Related | 2 (0.17) | 2 (0.17) | 0.36 |
| Aggregate Leak | 7 (0.61) | 15 (1.31) | 0.087 |
| Aggregate Bleeding | 4 (0.35) | 11 (0.96) | 0.069 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94729
Program Number: P185
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster