Robot-assisted versus laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a propensity score-matched comparative analysis using the 2015–2016 MBSAQIP database

Raul Sebastian, Melanie H. Howell, Kai Hua Chang, Gina Adrales, Thomas Magnuson, Michael A Schweitzer, Hien Nguyen

Research output: Contribution to journalArticle

Abstract

Background: Robotic-assisted bariatric surgery is part of the armamentarium in many bariatric centers. However, limited data correlate the robotic benefits to with clinical outcomes. This study compares 30-day outcomes between robotic-assisted and laparoscopic procedures for Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Methods: Using the 2015–2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, patients between18- and 65-year-old were included. To adjust for potential confounders, 1:1 propensity-score matching (PSM) was performed using 22 preoperative characteristics. Second PSM analysis was performed adding operative time and conversion rate. Results: 269,923 patients underwent SG (n = 190,494) or RYGB (n = 79,429). The operative time was significantly longer in the Robotic-assisted compared to laparoscopic approach either for SG (102.58 ± 46 vs. 73.38 ± 36; P < 0.001) or for RYGB (158.29 ± 65 vs. 120.17 ± 56; P < 0.001). In the SG cohort (12,877 matched cases), the robotic approach showed significant reduction of postoperative bleeding (0.16% vs. 0.43%; P < 0.001) and strictures (0.19% vs. 0.33%; P = 0.04) with similar results in the other 30-day outcomes in both analyses. Similarly, for the RYGB cohort (5780 matched cases), the robotic approach showed significantly fewer requirements for blood transfusions (0.64% vs. 1.16%; P = 0.004) with no statistically different results for the other’s outcomes. Conversely, when adding operative time and conversion rate to the PSM analysis, the robotic platform showed significantly shorter length of stay (2.12 ± 1.9 vs. 2.30 ± 3.1 days; P < 0.001), reduction of anastomotic leak (0.52% vs. 0.92%; P = 0.01), renal complications (0.16% vs. 0.38%; P = 0.004), and venous thromboembolism (0.24% vs. 0.52%; P = 0.02). Conclusions: Our findings show that postoperative bleeding and blood transfusion are significantly reduced with the robotic platform, and after correcting for all factors including operative time, the robotic-assisted approach is associated with better postoperative outcomes especially for RYGB.

Original languageEnglish (US)
JournalSurgical Endoscopy and Other Interventional Techniques
DOIs
StateAccepted/In press - Jan 1 2018

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Propensity Score
Bariatric Surgery
Gastric Bypass
Accreditation
Robotics
Gastrectomy
Quality Improvement
Databases
Operative Time
Blood Transfusion
Hemorrhage
Bariatrics
Anastomotic Leak
Venous Thromboembolism
Length of Stay
Pathologic Constriction
Kidney

Keywords

  • Bariatric surgery
  • Minimally invasive surgery
  • Robotic bariatric surgery
  • Robotic gastric bypass
  • Robotic sleeve gastrectomy

ASJC Scopus subject areas

  • Surgery

Cite this

@article{122b66c907fd44f49d7711979c204b04,
title = "Robot-assisted versus laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a propensity score-matched comparative analysis using the 2015–2016 MBSAQIP database",
abstract = "Background: Robotic-assisted bariatric surgery is part of the armamentarium in many bariatric centers. However, limited data correlate the robotic benefits to with clinical outcomes. This study compares 30-day outcomes between robotic-assisted and laparoscopic procedures for Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Methods: Using the 2015–2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, patients between18- and 65-year-old were included. To adjust for potential confounders, 1:1 propensity-score matching (PSM) was performed using 22 preoperative characteristics. Second PSM analysis was performed adding operative time and conversion rate. Results: 269,923 patients underwent SG (n = 190,494) or RYGB (n = 79,429). The operative time was significantly longer in the Robotic-assisted compared to laparoscopic approach either for SG (102.58 ± 46 vs. 73.38 ± 36; P < 0.001) or for RYGB (158.29 ± 65 vs. 120.17 ± 56; P < 0.001). In the SG cohort (12,877 matched cases), the robotic approach showed significant reduction of postoperative bleeding (0.16{\%} vs. 0.43{\%}; P < 0.001) and strictures (0.19{\%} vs. 0.33{\%}; P = 0.04) with similar results in the other 30-day outcomes in both analyses. Similarly, for the RYGB cohort (5780 matched cases), the robotic approach showed significantly fewer requirements for blood transfusions (0.64{\%} vs. 1.16{\%}; P = 0.004) with no statistically different results for the other’s outcomes. Conversely, when adding operative time and conversion rate to the PSM analysis, the robotic platform showed significantly shorter length of stay (2.12 ± 1.9 vs. 2.30 ± 3.1 days; P < 0.001), reduction of anastomotic leak (0.52{\%} vs. 0.92{\%}; P = 0.01), renal complications (0.16{\%} vs. 0.38{\%}; P = 0.004), and venous thromboembolism (0.24{\%} vs. 0.52{\%}; P = 0.02). Conclusions: Our findings show that postoperative bleeding and blood transfusion are significantly reduced with the robotic platform, and after correcting for all factors including operative time, the robotic-assisted approach is associated with better postoperative outcomes especially for RYGB.",
keywords = "Bariatric surgery, Minimally invasive surgery, Robotic bariatric surgery, Robotic gastric bypass, Robotic sleeve gastrectomy",
author = "Raul Sebastian and Howell, {Melanie H.} and Chang, {Kai Hua} and Gina Adrales and Thomas Magnuson and Schweitzer, {Michael A} and Hien Nguyen",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s00464-018-6422-7",
language = "English (US)",
journal = "Surgical Endoscopy",
issn = "0930-2794",
publisher = "Springer New York",

}

TY - JOUR

T1 - Robot-assisted versus laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy

T2 - a propensity score-matched comparative analysis using the 2015–2016 MBSAQIP database

AU - Sebastian, Raul

AU - Howell, Melanie H.

AU - Chang, Kai Hua

AU - Adrales, Gina

AU - Magnuson, Thomas

AU - Schweitzer, Michael A

AU - Nguyen, Hien

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Robotic-assisted bariatric surgery is part of the armamentarium in many bariatric centers. However, limited data correlate the robotic benefits to with clinical outcomes. This study compares 30-day outcomes between robotic-assisted and laparoscopic procedures for Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Methods: Using the 2015–2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, patients between18- and 65-year-old were included. To adjust for potential confounders, 1:1 propensity-score matching (PSM) was performed using 22 preoperative characteristics. Second PSM analysis was performed adding operative time and conversion rate. Results: 269,923 patients underwent SG (n = 190,494) or RYGB (n = 79,429). The operative time was significantly longer in the Robotic-assisted compared to laparoscopic approach either for SG (102.58 ± 46 vs. 73.38 ± 36; P < 0.001) or for RYGB (158.29 ± 65 vs. 120.17 ± 56; P < 0.001). In the SG cohort (12,877 matched cases), the robotic approach showed significant reduction of postoperative bleeding (0.16% vs. 0.43%; P < 0.001) and strictures (0.19% vs. 0.33%; P = 0.04) with similar results in the other 30-day outcomes in both analyses. Similarly, for the RYGB cohort (5780 matched cases), the robotic approach showed significantly fewer requirements for blood transfusions (0.64% vs. 1.16%; P = 0.004) with no statistically different results for the other’s outcomes. Conversely, when adding operative time and conversion rate to the PSM analysis, the robotic platform showed significantly shorter length of stay (2.12 ± 1.9 vs. 2.30 ± 3.1 days; P < 0.001), reduction of anastomotic leak (0.52% vs. 0.92%; P = 0.01), renal complications (0.16% vs. 0.38%; P = 0.004), and venous thromboembolism (0.24% vs. 0.52%; P = 0.02). Conclusions: Our findings show that postoperative bleeding and blood transfusion are significantly reduced with the robotic platform, and after correcting for all factors including operative time, the robotic-assisted approach is associated with better postoperative outcomes especially for RYGB.

AB - Background: Robotic-assisted bariatric surgery is part of the armamentarium in many bariatric centers. However, limited data correlate the robotic benefits to with clinical outcomes. This study compares 30-day outcomes between robotic-assisted and laparoscopic procedures for Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Methods: Using the 2015–2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, patients between18- and 65-year-old were included. To adjust for potential confounders, 1:1 propensity-score matching (PSM) was performed using 22 preoperative characteristics. Second PSM analysis was performed adding operative time and conversion rate. Results: 269,923 patients underwent SG (n = 190,494) or RYGB (n = 79,429). The operative time was significantly longer in the Robotic-assisted compared to laparoscopic approach either for SG (102.58 ± 46 vs. 73.38 ± 36; P < 0.001) or for RYGB (158.29 ± 65 vs. 120.17 ± 56; P < 0.001). In the SG cohort (12,877 matched cases), the robotic approach showed significant reduction of postoperative bleeding (0.16% vs. 0.43%; P < 0.001) and strictures (0.19% vs. 0.33%; P = 0.04) with similar results in the other 30-day outcomes in both analyses. Similarly, for the RYGB cohort (5780 matched cases), the robotic approach showed significantly fewer requirements for blood transfusions (0.64% vs. 1.16%; P = 0.004) with no statistically different results for the other’s outcomes. Conversely, when adding operative time and conversion rate to the PSM analysis, the robotic platform showed significantly shorter length of stay (2.12 ± 1.9 vs. 2.30 ± 3.1 days; P < 0.001), reduction of anastomotic leak (0.52% vs. 0.92%; P = 0.01), renal complications (0.16% vs. 0.38%; P = 0.004), and venous thromboembolism (0.24% vs. 0.52%; P = 0.02). Conclusions: Our findings show that postoperative bleeding and blood transfusion are significantly reduced with the robotic platform, and after correcting for all factors including operative time, the robotic-assisted approach is associated with better postoperative outcomes especially for RYGB.

KW - Bariatric surgery

KW - Minimally invasive surgery

KW - Robotic bariatric surgery

KW - Robotic gastric bypass

KW - Robotic sleeve gastrectomy

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UR - http://www.scopus.com/inward/citedby.url?scp=85053599663&partnerID=8YFLogxK

U2 - 10.1007/s00464-018-6422-7

DO - 10.1007/s00464-018-6422-7

M3 - Article

C2 - 30225604

AN - SCOPUS:85053599663

JO - Surgical Endoscopy

JF - Surgical Endoscopy

SN - 0930-2794

ER -