Contemporary analysis of early outcomes following robotic cholecystectomy in the United States.

Abstract

Over the past decade, robotic-assisted approaches for cholecystectomy have represented a rapidly increasing proportion of all cases. Despite purported advantages in improved visualization and dexterity, recent studies have suggested increased rates of bile duct injury. These studies have nonetheless been limited in scope to single-payer populations. Patients undergoing robotic, laparoscopic, or open cholecystectomy were queried from the 2016 to 2022 Nationwide Readmissions Database. Mixed multivariable regression models were then developed to determine the association of surgical approach with bile duct injury, postoperative gastroenterology/interventional radiology intervention, death, major complication, postoperative length of stay, and costs. Of 1,378,954 patients, 69,115 (5.0%) underwent robotic cholecystectomy; 1,186,649 (86.1%) had laparoscopic operations; and 123,190 (8.9%) had an open operation. From 2016 to 2022, the proportion of robotic operations significantly increased from 1.5% to 11.7% (P < .001). After adjustment with open as reference, robotic cholecystectomy was associated with reduced odds of bile duct injury (adjusted odds ratio, 0.15; 95% confidence interval, 0.09-0.24), additional procedures (adjusted odds ratio, 0.53; 95% confidence interval, 0.48-0.60), death (adjusted odds ratio, 0.26; 95% confidence interval, 0.22-0.30), and major complications (adjusted odds ratio, 0.46; 95% confidence interval, 0.44-0.49). Robotic cholecystectomy was also associated with reduced postoperative length of stay (β = 3.4 days; 95% confidence interval, -3.5 to -3.3) but higher costs (β = $1,000; 95% confidence interval, 400-1,600). Subgroup analysis directly comparing robotic and laparoscopic operations revealed similar odds of bile duct injury but reduced major complications, additional procedures, and postoperative length of stay with robotic operations. In this contemporary multipayer study, outcomes after robotic cholecystectomy are similar compared with laparoscopic operations. Furthermore, both approaches appear to confer a significant advantage over open operations. Our findings may reflect a nationwide inflection point in robotic surgical aptitude.