Anesthesiological considerations and complications in robotic surgery: a retrospective analysis

Robotic-assisted surgery has become increasingly prevalent across various surgical disciplines. Understanding anesthesiological factors influencing perioperative outcome is essential for optimizing patient care. This retrospective analysis evaluated 200 patients who underwent robotic surgery across three surgical categories: gastrointestinal (GI, n=60), hepatopancreticobiliary (HPB, n=28), and colorectal (n=112) procedures. We conducted an exploratory analysis of associations between anesthesiological parameters-including fluid management, surgical duration, and blood loss-and clinical outcomes such as intensive care unit (ICU) length of stay, total hospital length of stay, complication severity (Clavien-Dindo classification) using univariable and multivariable regression models. The exploratory analyses suggested potential associations between surgical duration and outcomes across surgical specialties in multivariable analysis. For GI procedures, longer surgical duration was associated with higher odds of severe complications (Clavien-Dindo grade ≥III; OR = 1.80 (1.21, 2.66)). In colorectal surgery, surgical duration was independently associated with both development of severe complications (OR = 1.28 (1.01, 1.62)) and total hospital length of stay (log-scale, β = 0.08 (0.03, 0.12)). Fluid intake was associated with an increased hospital length of stay in colorectal surgery (log-scale, β = 0.10 (0.03, 0.17)). Anesthesiological management, particularly surgical duration and fluid management, showed associations with perioperative outcomes in robotic surgery. The estimated effects provide preliminary insights into the magnitude of these associations and may serve as a basis for hypothesis generation and the design of future prospective studies. Further studies are needed to confirm these findings and to investigate the potential clinical relevance of anesthesiological and perioperative management strategies.