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Outcomes following revision and conversion robotic-assisted compared to conventional laparoscopic bariatric surgery: a review of the 2015 and 2016 MBSAQIP Participant User Files database

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.

Outcomes in case-controlled matched cohorts
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

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