Impact of Increasing Robotic Bariatric Utilization on Duodenal Switch Procedure Outcomes

The growth rate of robotic bariatric surgery has recently increased compared to prior years. The impact of this new growth rate on duodenal switch procedures (DSPs) remains uncertain.

DSPs performed using robotic assistance (RDSPs) or conventional laparoscopy (LDSPs) were identified from the 2015 to 2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) databases. Then, 1:1 matched analysis compared outcomes between all RDSPs and LDSPs, and those performed during different operative periods (2015-2018 and 2019-2021).

Then, 14,679 DSPs (73.6% LDSPs and 26.4% RDSPs) were analyzed. Matched analyses compared 2081 RDSPs to 2081 LDSPs. Mean operation length (p < 0.001) and hospital length of stay (LOS) (p < 0.001) were longer for RDSPs. The risk of surgical site infection (SSI) (OR 1.37), readmission (OR 1.34), reintervention (OR 1.39), and overall morbidity (OR 1.34) were significantly higher for RDSPs. RDSPs performed between 2015 and 2018 also had longer operative duration and hospital length of stay, but comparable outcomes to LDSPs. In contrast, RDSPs performed from 2019 to 2021 had higher SSI (OR 1.81), readmission (OR 2.02), reintervention (OR 2.08), and overall morbidity (OR 1.8) risk. Operation duration also remains longer for RDSPs, but similar hospital length of stay.

In this matched analysis, both RDSPs and LDSPs were safe. With bariatric growth, more recently performed RDSPs appear to be associated with an increase in some adverse outcomes.