Robotic Care Outcomes Project (ROBOCOP) for elective cholecystectomy

Abstract

BACKGROUND: Robotic cholecystectomy (RCHOLE) is being used more frequently for elective patients. We aimed to compare clinical outcomes, specifically conversion to open/subtotal cholecystectomy, for RCHOLE and laparoscopic cholecystectomy (LCHOLE). METHODS: Our study received a Non-Human Subjects Research Determination. We studied elective laparoscopic (LCHOLE) and robotic (RCHOLE) cases from 2020 to 2022 using de-identified extraction of electronic US hospital health record data from the Intuitive Custom Hospital Analytics database. LCHOLE and RCHOLE cases, conversion to open/subtotal cholecystectomy, and complications were identified using ICD10 and/or CPT codes. Patients with missing operative times and demographics were excluded (n = 11,276). We used Multivariate Logistic Regression with Inverse Probability Treatment Weighting(MLR/IPTW) to balance covariates. R 4.1.1 was used for analysis. RESULTS: LCHOLE(n = 93,122) and RCHOLE(n = 23,581) had similar mean age(50 years) and gender(70% female); RCHOLE patients were more frequently obese(BMI ≥ 30 kg/m2, 38.0% vs. 33.4%, p < 0.001). Operative time was longer in RCHOLE(107 ± 53 vs. 93 ± 42 min, p < 0.001). After MLR/IPTW, RCHOLE had decreased odds of conversion to open cholecystectomy (OR 0.51 [95%CI 0.42, 0.61, p < 0.001), but similar odds of subtotal cholecystectomy. Readmission (OR 0.89 [0.81, 0.97, p = 0.008]) hospital acquired conditions (OR 0.71 [0.60, 0.83, p < 0.001]), and bile duct injury (OR 0.00, p < 0.001) were less likely with RCHOLE. Odds of surgical site infection and hospital mortality were similar in both groups. CONCLUSIONS: In the elective setting, robotic cholecystectomy has reduced odds of conversion to open, readmission, and hospital acquired conditions including bile duct injury when compared to laparoscopic cholecystectomy.