Elective robotic-assisted bariatric surgery: Is it worth the money? A national database analysis

Abstract

Background: This study sought to evaluate surgical outcomes, cost, and opiate utilization between patients who underwent either laparoscopic or robotic-assisted bariatric procedures, including sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB).

Methods: The Vizient administrative database was queried for patients admitted with mild to moderate severity of illness scores who underwent elective laparoscopic (L) and robotic-assisted (R) SG or RYGB from October 2015 through December 2018. Patients were grouped according to surgical approach for each bariatric procedure. Rates of overall complications, mortality, 30-day readmission, LOS, total direct cost, and opiate utilization were collected. Comparisons were performed within each bariatric procedure, between laparoscopic and robotic approaches, using IBM SPSS v.25.0, α = 0.05.

Results: For SG, a total of 84,034 patients were included (LSG:N = 78,405; RSG:N = 5639). There was no significant difference in rates of overall complications (LSG:0.5%, RSG:0.4%; p = 0.872), mortality (LSG:<0.01%, RSG:<0.01%; p = 0.660), and 30-day readmissions (LSG: 0.5%, RSG:0.5%; p = 0.524). Average LOS was 1.65 ± 1.07 days for LSG and 1.77 ± 1.29 days for RSG (p=<0.001). Robotic approach had a significantly higher direct cost (LSG: $6505 ± 3,200, RSG: $8018 ± 3849; p=<0.001). Rate of opiate use was 97.3% for both groups (p=>0.05). For RYGB, 36,039 patients met the inclusion criteria (LRYGB:N = 33,053; RRYGB:N = 2986). There was no significant difference in rates of overall complications (LRYGB: 1.4%, RRYGB:1.3%; p = 0.414) or mortality (LRGYB:<0.01%, RRYGB: <0.01%; p = 0.646). Robotic approach was associated with a lower 30-day readmission rate (LRYGB: 1.3%, RRYGB:<0.01%; p=<0.001). Average LOS was 2.1 ± 2.18 days for LRYGB and 2.18 ± 3.78 days for RRYGB (p = 0.075). Robotic approach had a significantly higher direct cost (LRYGB:$8564 ± 5,350, RRYGB: $10,325 ± 7689; p=<0.001) and rate of opiate use (LRYG:95.75%, RRYGB:96.85%; p = 0.005).

Conclusion: Our study found the direct cost of RSG to be significantly higher than LSG with no added clinical benefit, therefore, universal use of the robotic platform for routine SG cases remains difficult to justify. While the direct cost of RRYGB was also higher than LRYGB, the significantly lower readmission rate associated with robotic approach may help to offset the financial discrepancy and warrant its use.

Keywords: Bariatrics; Cost · outcomes; Minimally invasive surgery; Opiate use.