Robotic Care Outcomes Project (ROBOCOP) for elective cholecystectomy

Robotic cholecystectomy (RCHOLE) is being used more frequently for elective patients. We aimed to compare clinical outcomes, specifically conversion to open/subtotal cholecystectomy, for RCHOLE and laparoscopic cholecystectomy (LCHOLE).

Our study received a Non-Human Subjects Research Determination. We studied elective laparoscopic (LCHOLE) and robotic (RCHOLE) cases from 2020 to 2022 using de-identified extraction of electronic US hospital health record data from the Intuitive Custom Hospital Analytics database. LCHOLE and RCHOLE cases, conversion to open/subtotal cholecystectomy, and complications were identified using ICD10 and/or CPT codes. Patients with missing operative times and demographics were excluded (n = 11,276). We used Multivariate Logistic Regression with Inverse Probability Treatment Weighting(MLR/IPTW) to balance covariates. R 4.1.1 was used for analysis.

LCHOLE(n = 93,122) and RCHOLE(n = 23,581) had similar mean age(50 years) and gender(70% female); RCHOLE patients were more frequently obese(BMI ≥ 30 kg/m2, 38.0% vs. 33.4%, p < 0.001). Operative time was longer in RCHOLE(107 ± 53 vs. 93 ± 42 min, p < 0.001). After MLR/IPTW, RCHOLE had decreased odds of conversion to open cholecystectomy (OR 0.51 [95%CI 0.42, 0.61, p < 0.001), but similar odds of subtotal cholecystectomy. Readmission (OR 0.89 [0.81, 0.97, p = 0.008]) hospital acquired conditions (OR 0.71 [0.60, 0.83, p < 0.001]), and bile duct injury (OR 0.00, p < 0.001) were less likely with RCHOLE. Odds of surgical site infection and hospital mortality were similar in both groups.

In the elective setting, robotic cholecystectomy has reduced odds of conversion to open, readmission, and hospital acquired conditions including bile duct injury when compared to laparoscopic cholecystectomy.