Redefining Clavien-Dindo Classification in MBSAQIP: Laparoscopic Vs. Robotic Sleeve Gastrectomy

The Clavien-Dindo classification (CDC) grades complications based on required interventions, yet prior MBSAQIP studies used arbitrary assignments, limiting standardization. Comparative safety between robotic (RSG) and laparoscopic sleeve gastrectomy (LSG) remains inconsistent. We assigned CDC grades using treatment-level data and compared 30-day outcomes between RSG and LSG.

We conducted a retrospective cohort study using MBSAQIP data (2020-2023) comparing primary laparoscopic and robotic sleeve gastrectomy. Clavien-Dindo grades were assigned using treatment-level data, including reoperation, reintervention, readmission, and ICU care. Cumulative morbidity was assessed with the Comprehensive Complication Index (CCI), with CCI ≥26.2 indicating significant morbidity. Multivariable regression evaluated associations between surgical approach and CDC grades.

Among 480,280 patients, 73% underwent LSG and 27% RSG. The RSG cohort had higher BMI (45.3 vs 44.8 kg/m², p<0.001), a greater proportion of Black patients (24.2% vs 21%, p<0.001), and more comorbidities (1.7 vs 1.6, p<0.001). Unadjusted complication rates were higher for RSG: any CDC grade (7.3% vs 6.9%, p=0.002), CDC I/II (5.9% vs 5.6%, p<0.001), CDC IVa (0.6% vs 0.5%, p=0.008), and high CCI (1.6% vs 1.4%, p<0.001). After adjustment, no significant differences were observed for any CDC grade (OR 1.017, 95% CI 0.990-1.044, p=0.226) or high CCI (OR 1.057, 95% CI 0.999-1.119, p=0.054).

This is the first study assigning MBSAQIP complications to CDC grades based on treatment details. There were no significant differences in CDC grades or high CCI between RSG and LSG, suggesting that both procedures have comparable safety profiles.