ROBOtic Care Outcomes Project for acute gallbladder pathology

Abstract

Background Robotic cholecystectomy is being increasingly used for patients with acute gallbladder disease who present to emergency department, but clinical evidence is limited. We aimed to compare the outcomes of emergent laparoscopic and robotic cholecystectomies in a large real-world database. Methods Patients who received emergent laparoscopic or robotic cholecystectomies from 2020 to 2022 were identified from the Intuitive Custom Hospital Analytics database, based on de-identified extraction of electronic health record data from US hospitals. Conversion to open or subtotal cholecystectomy and complications were defined using ICD10 and/or CPT codes. Multivariate logistic regression with inverse probability treatment weighting (IPTW) was performed to compare clinical outcomes of laparoscopic versus robotic approach after balancing covariates. Cost analysis was performed with activity-based costing and adjustment for inflation. Results Of 26,786 laparoscopic and 3,151 robotic emergent cholecystectomy patients being included, 64% were female, 60% were ≥ 45 years, and 24% were obese. Approximately 5.5% patients presented with pancreatitis, and 4% each presenting with sepsis and biliary obstruction. After IPTW, distributions of all baseline covariates were balanced. Robotic cholecystectomy decreased odds of conversion to open (OR 0.68 [95%CI 0.49, 0.93, p = 0.035]), but increased odds of subtotal cholecystectomy (OR 1.64 [95% CI 1.03, 2.60, p = 0.037]). Surgical site infection, readmission, length of stay, hospital acquired conditions, bile duct injury or leak, and hospital mortality were similar in both groups. There was no significant difference in hospital cost. Conclusions Robotic cholecystectomy has reduced odds of conversion to open and comparable complications, but increased odds of subtotal cholecystectomy compared to laparoscopic cholecystectomy for acute gallbladder diseases. Further work is required to assess the long-term implications of these differences. Level of Evidence III, Therapeutic/Care Management Case-Control (Retrospective)