Robotic assisted versus laparoscopic duodenal switch procedures: A nationwide propensity score matched analysis.

BACKGROUND

Research comparing the outcomes of robotic-assisted and laparoscopic duodenal switch (DS) procedures in the US have relied primarily on the same data source and have not considered economic outcomes. Studies using alternative data sources are needed to better understand the health and economic impact of surgery modality for patients receiving DS procedures.

OBJECTIVE

To compare perioperative outcomes and cost between robotic-assisted and laparoscopic DS procedures.

SETTING

Data from the Premier Healthcare Database (PHD), a multi-center, hospital-based database.

METHODS

A retrospective cohort study from January 1, 2017, to December 31, 2023, including primary robotic-assisted or laparoscopic elective DS procedures. Propensity score matched analysis was performed. Perioperative and 30-day complications and cost were compared.

RESULTS

The study cohort included 4221 DS patients, 36 % robotic and 64 % laparoscopic. Patients receiving an R-DS had a higher BMI and Charlson Comorbidity Index (CCI). After matching, 1073 patients per cohort were analyzed. R-DS procedures had a longer median operative time (230 min vs. 186 min, p < .001) and less gastrointestinal (GI) bleeding (0.2 % vs. 0.9 %, p = .0021). All other adverse outcomes were comparable. For the matched cohort, there was a significant decrease in 30-day cost (p < .001) and complication rates (p < .001) for R-DS, but not L-DS. Median 30-day perioperative costs were similar for R-DS and L-DS in 2023 ($17,156 and $16,476 for R-DS and L-DS, respectively).

CONCLUSION

R-DS and L-DS have comparable outcomes and costs. Overall complications and costs associated with DS procedures are decreasing. R-DS procedures have longer operation time and lower risk of GI bleeding.