Background

Robotic-assisted approach has been increasingly used in bariatric surgery without proven benefit. The goal of this study was to compare outcomes between laparoscopic and robotic-assisted bariatric surgery.

Methods

The Nationwide Readmissions Database (NRD) was used to identify all hospitalizations for adult patients who underwent laparoscopic or robotic bariatric surgery from 2010 to 2019. Primary outcomes included post-operative complications and 30- and 90-day readmission rates. Secondary outcomes included in-hospital death, length of stay (LOS), and inflation-adjusted cost. Multivariable logistic regression models were estimated for overall complication and readmission rates. All presented hospitalization counts are weighted; all analyses accounted for the NRD sampling design.

Results

Approximately 1,445,375 hospitalizations met inclusion criteria, of which 6.9% were robotic-assisted. Patient demographics had similar ages in both groups (44 years) and distributions of comorbidities. The overall complication rate was higher for robotic-assisted surgeries (12.7% vs 10.3%, odds ratio [OR]: 1.3, 95% CI: 1.2-1.4, p < .001). Intra-abdominal injuries to surrounding structures and hemorrhage-related complications were higher for laparoscopic cases. There were similar 30-day readmission rates for robotic and laparoscopic cases (4.05% vs .30%, OR: 1.03, 95% CI: 0.97-1.10, p = .370) and 90-day (6.7% vs 6.9%, OR: 1.04 95% CI: 0.98-1.10, p = .217). The LOS in both groups were similar (1.18 vs. 1.14 days, p = .952); although, hospital costs were higher for robotic-assisted cases ($15,711 vs. $11,810, p < .001).

Conclusions

Our analysis suggests that robotic-assisted bariatric surgery is associated with higher overall complication rates and hospital costs than the laparoscopic approach.