The Longitudinal Efficiency of Robotic Surgery: an MBSAQIP Propensity Matched 4-Year Comparison of Robotic and Laparosco
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ORIGINAL CONTRIBUTIONS
The Longitudinal Efficiency of Robotic Surgery: an MBSAQIP Propensity Matched 4-Year Comparison of Robotic and Laparoscopic Bariatric Surgery Mark Dudash 1 & Jason Kuhn 1 & James Dove 1 & Marcus Fluck 1 & Ryan Horsley 1 & Jon Gabrielsen 1 & Mustapha Daouadi 1 & Anthony T. Petrick 1 & David M. Parker 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The objective of this study was to examine the MBSAQIP database to assess efficiency trends and perioperative outcomes in robotic bariatric surgery. Methods Robotic (RA) and laparoscopic (L) sleeve gastrectomy (SG) and gastric bypass (RYGB) were compared using the 2015–2018 MBSAQIP Participant Use Data Files. Patients were propensity matched 1:1 based on sex, body mass index, assistant, and previous obesity or foregut surgery. A total of 93,802 patients were included. Results Median operative times were significantly longer for both RA-SG (89 vs. 62 min; p < 0.0001) and RA-RYGB (141 vs. 105 min; p < 0.0001) compared with laparoscopic. Over the 4-year period, the difference in operative times (OR delta) between RA-SG and L-SG was unchanged while the difference in operative times between RA-RYGB and L-RYGB increased. Both robotic groups were significantly more likely to be readmitted (RA-SG p = 0.001, RA-RYGB p = 0.006). Robotic SG was more likely to have a reintervention (p = 0.018) and extended length of stay (LOS) (> 4 days) compared with laparoscopic (p = < 0.0002). No significant differences were noted in morbidity and mortality by approach. Conclusions Operative times were 30% longer for RA-SG and 25% longer for RA-RYGB when compared with laparoscopic. There was no significant improvement in OR delta for either RA-SG or RA-RYGB over the four years. Readmission rates were higher for both RA-SG and RA-RYGB. Robotic SG had a greater percentage of patients with extended LOS compared with laparoscopic. No evidence of improved efficiency for robotic bariatric surgery as defined by operative time or clinical outcomes was identified. Keywords Operative time . Robotic surgery . Bariatric surgery . Gastric bypass . Gastric sleeve . MBSAQIP . Learning curve
Introduction In 2003, Intuitive Surgical (Sunnyvale, CA) merged with Computer Motion (Goleta, CA) effectively creating a single robotic vendor. Since then, there have been substantial technologic advances in the Da Vinci® surgical platform aimed primarily at improving operative efficiency. In surgical literature, there is no single definition of “the learning curve”; however, it is generally accepted that increased volume and
* David M. Parker [email protected] 1
Department of General Surgery, Geisinger Medical Center, 100 N. Academy Avenue, MC 21-69, Danville, PA 17822, USA
experience performing a procedure will result in greater efficiency and improved clinical outcomes. [1] The current standard of care for bariatric surgery is the laparoscopic approach. Examination of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program
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