Edwin Acevedo, MD1, Michael Mazzei, MD, MPH, MS1, Huaqing Zhao, PhD, MS2, Xiaoning Lu, MS2, Rohit Soans, MD2, Michael A Edwards, MD, FACS, FASMBS2. 1Temple University Hospital, 2Lewis Katz School of Medicine at Temple University
Introduction: Robotic-assisted bariatric surgery (RBS) is increasingly performed. The overall benefit of RBS compared to conventional laparoscopic bariatric surgery (LBS) remain controversial. In this study, we compare outcomes between RBS and LBS using a large risk-stratified clinical database. We hypothesize that LBS is safer and more cost-effective than RBS.
Methods: A retrospective analysis of the 2015 and 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was performed. Primary RBS and LBS were analyzed. 1:1 case-controlled matching was performed. 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: 278,761 primary bariatric operations were identified (93% LBS, 7% RBS). 79% were female and 64.7% white. Mean age and BMI were 44.6 years and 45.5 kg/m2. 16,291 matched RBS and LBS cases and controls were identified, and outcomes compared (Table 1). Conversion rate was higher in RBS (0.53% vs 0.1%, p<0.0001). RBS was associated with longer OL (118min vs 85min, p<0.0001) and HLOS (1.83days vs 1.7days, p<0.0001). Readmission, reintervention, reoperation and leak rates were higher in RBS. Bleeding, cardiac arrest and 30-day mortality rates were higher in LBS. There was no difference in mortality related to bariatric surgery (p 0.74).
Conclusion: Robotic-assisted bariatric surgery is associated with longer OL, HLOS and higher complication rates, likely contributing to less cost-effectiveness. Both approaches remain safe, but LBS is associated with a higher all-cause 30-day mortality.
| Table1. Matched cohort outcomes | |||
|---|---|---|---|
| Approach | |||
| Outcomes, N (%) | LBS (N=16,291) | RBS (N=16,291) | p-value |
| 30-Day Readmission | 604 (3.71) | 715 (4.39) | 0.0018 |
| 30-Day Intervention | 229 (1.41) | 278 (1.71) | 0.0028 |
| 30-Day Reoperation | 194 (1.19) | 232 (1.42) | 0.064 |
| 30-Day Mortality | 18 (0.11) | 8 (0.05) | 0.05 |
| CPR | 12 (0.07) | 3 (0.02) | 0.02 |
| Transfusion | 96 (0.59) | 66 (0.41) | 0.018 |
| Aggregate Bleeding | 68 (0.42) | 48 (0.29) | 0.063 |
| Organ Space SSI | 35 (0.21) | 62 (0.38) | 0.006 |
| 30-Day Drain Present | 27 (0.17) | 70 (0.43) | <0.0001 |
| Agregate Leak | 36 (0.22) | 66 (0.41) | 0.0029 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94250
Program Number: P117
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster