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Robotic primary Roux-en-Y gastric bypass is independently associated with increased 30-day mortality: a 2023 MBSAQIP
Valentin Mocanu1, Mélissa V Wills1, Salvador Navarrete1
1Digestive Disease Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
Background:
The implementation of robotic Roux-en-Y gastric bypass (R-RYGB) has been met with tremendous enthusiasm over the last decade. Yet, despite the rapidly increasing adoption of robotic delivery, remarkably little is known about the impact of modern R-RYGB on short-term morbidity and mortality.
Objectives:
The objective of this study was to characterize and evaluate differences in 30-day morbidity and mortality between patients receiving elective RYGB cases through either laparoscopic or robotic approaches in 2023.
Setting:
All participating Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) centers entering data in the most recent 2023 operative year.
Methods:
A retrospective analysis of the 2023 MBSAQIP database was performed by identifying all elective primary laparoscopic (L-RYGB) and robotic RYGB cases. Bivariate analysis was conducted using either χ2 tests or Wilcoxon rank sum tests as appropriate. Multivariable logistic regression analysis was then used to identify independent predictors of morbidity and mortality.
Results:
A total of 50,365 patients underwent RYGB, of whom 19,553 (38.8%) received R-RYGB. There were no clinically relevant differences with respect to age (44.6 ± 11.6 R-RYGB versus 44.4 ± 11.5 L-RYGB; P = .05), body mass index (45.6 ± 7.8 R-RYGB versus 45.3 ± 7.5 L-RYGB; P < .0001), or female sex (83.1% R-RYGB versus 83.3% L-RYGB; P = .6) between cohorts. R-RYGB patients were more likely to have reflux (46.4% versus 41.6%; P < .0001), undergo concurrent paraesophageal hernia repair (19.4% versus 15.8%; P < .0001), and have increased operative length (139.7 ± 55.5 min versus 115.2 ± 53.7 min; P < .0001). L-RYGB patients had higher rates of bleeding (1.5% versus 1.2%; P = .001), whereas R-RYGB patients had higher 30-day rates of readmission (5.3% versus 4.3%; P < .0001), cardiac events (.2% versus .1%; P = .005), and mortality (.14% versus .07%; P = .02%). After adjusting for patient and technical factors, robotic delivery was independently associated with increased mortality (odds ratio: 2.10; 95% confidence interval: 1.11-3.96; P = .02).
Conclusion:
In 2023, robotic RYGB comprised only 39% of elective cases yet over one half of all deaths occurring within 30 days. Multivariable regression demonstrated a 2-fold increased mortality associated with robotic delivery. Caution should be employed as robotic approaches become increasingly adopted with emphasis made on training standardization and center accreditation.
