Navigating decision-making for high-cost robotic surgery in the emergency department: an acute care surgery experience.

Although robotic surgery is increasingly applied in acute care surgery (ACS), the preoperative decision-making process in the emergency department (ED) remains poorly understood. This study evaluated the feasibility and factors associated with choosing high-cost robotic surgery in an acute setting. This single-center retrospective study included ED patients undergoing urgent cholecystectomy between December 2025 and July 2026. Decision-making metrics and sociodemographic factors were compared between robotic (RC) and laparoscopic cholecystectomy (LC). Multivariable logistic regression identified factors independently associated with choosing RC, and a subgroup analysis evaluated whether the decision was finalized during the ED stay among RC patients. Among 107 patients, 46 (43.0%) underwent RC and 61 (57.0%) underwent LC. RC patients required a longer time from consultation to consent (19.1 vs. 11.4 h, p < 0.001) and more counseling sessions (2.4 vs. 1.1, p < 0.001). Nevertheless, 54.3% of RC patients finalized their decision during their ED stay. Younger age (OR = 0.891, 95% CI 0.813-0.976, p = 0.013), family presence in the ED (OR = 5.001, 95% CI 4.213-5.936, p < 0.001), a greater number of counseling sessions (OR = 1.276, 95% CI 1.064-1.530, p = 0.009), and commercial insurance coverage (OR = 2.235, 95% CI 1.899-2.630, p < 0.001) were independently associated with choosing RC. Among RC patients, younger age and greater family involvement were associated with finalizing the decision during the ED stay (both p < 0.001). High-cost robotic surgery can be integrated into the ACS setting despite a more complex decision-making process. Patient, family, financial, and counseling-related factors were associated with the choice of robotic surgery.