Increased Adoption of Robot-Assisted Appendectomy Without Improved Outcomes and Lower Modeled Value

Robot-assisted appendectomy use is increasing despite uncertain clinical benefit and economic value relative to laparoscopy. We evaluated comparative outcomes, operative efficiency, and modeled value.

We conducted a retrospective cohort study of adults undergoing intended minimally invasive appendectomy for appendicitis using 2022-2024 ACS NSQIP data. Robotic utilization was assessed among 140,148 patients. Clinical outcomes were compared using 1:2 propensity-score matching. The primary endpoint combined unplanned conversion to open surgery, postoperative transfusion, organ-space surgical-site infection, and reoperation. Surgical costs were simulated using literature-derived inputs; value incorporated risk-adjusted outcomes and simulated costs.

Robotic utilization increased from 0.7% in 2022 to 2.7% in 2024. Among 2,257 robot-assisted and 4,514 matched laparoscopic cases, the primary composite occurred in 5.5% versus 5.3% (OR 1.06; 95% CI 0.85-1.32; P=.61). Robot-assisted appendectomy required 15.48 additional operative minutes (95% CI 13.66-17.31; P<.001), without significant differences in readmission, mortality, or length of stay. Median simulated costs were $4,526 versus $2,416. Laparoscopic-to-robotic modeled value ratios ranged from 1.53 to 1.80. Even assuming no incremental robotic procedural-cost premium, laparoscopy retained higher modeled value for the primary composite (ratio 1.31; 95% CI 1.09-1.54). Exploratory analyses of complicated appendicitis and BMI ≥40 kg/m² identified no significant clinical advantage with robotics.

Robot-assisted appendectomy utilization increased nearly fourfold without an observed improvement in short-term outcomes. Longer operative time, higher simulated costs, and lower modeled value persisted across sensitivity analyses, supporting continued scrutiny of robotic adoption for an operation effectively performed laparoscopically.