Robotic emergency surgery in geriatric care

Older adults present unique challenges in emergency general surgery (EGS) due to increased comorbidities and frailty. While minimally invasive surgery (MIS), including laparoscopic (lap) and robotic techniques, reduces perioperative morbidity, the role of minimally invasive EGS in geriatric patients remains unclear. This study compares outcomes for geriatric EGS patients following robotic, lap, and open procedures. We hypothesize that MIS approaches would improve perioperative outcomes in geriatric patients.

We conducted a retrospective analysis of the ACS-NSQIP database (2022-2023) including patients ≥65 years undergoing emergent or urgent intra-abdominal surgery. Operative approach was categorized as robotic, lap, or open. The primary outcome was severe complication, and secondary outcomes included length of stay (LOS), discharge disposition, and readmission.

58,940 patients were included: 1832 robotic, 30,137 lap, and 26,971 open. With robotic vs lap and open, operative time was shortest (82.5 vs 110 vs 96 min, p < 0.001), conversion to open was less frequent (6.2 vs 12.9%, p < 0.001), and LOS was shorter (4 vs 4 vs 8 days, p < 0.001). Readmission and reoperation were lowest following MIS (9.2 vs 7.9 vs 9.8%, and 3.7 vs 3.3% vs 7.6%, both p < 0.001). After propensity matching, robotic patients had higher ASA scores and more transfusions but lower rates of sepsis (2.6 vs 6.5%) and mortality (2.3 vs 2.7%) compared to the lap group (p < 0.001). Multivariable regression demonstrated decreased risk of severe complications for patients who underwent robotic surgery (p = 0.025) with no difference in operative time or LOS, and patients were more likely to be discharged home.

Robotic EGS in geriatric patients is associated with fewer severe complications, lower conversion rates, shorter LOS, and favorable discharge disposition.