M. Nakhla2, Y. Seo2, S. Sareh3, Y. Sanaiha1, P. Benharash1 1University Of California – Los Angeles,Department Of Surgery,Los Angeles, CA, USA 2David Geffen School Of Medicine, University Of California At Los Angeles,Los Angeles, CA, USA 3Los Angeles County Harbor-UCLA,Los Angeles, CALIFORNIA, USA
Introduction: Laparoscopic cholecystectomy (LC) has reached nearly universal adoption in the management of gallstone-related disease. With rapid advances in technology, robotic cholecystectomy (RC) operations have been increasingly utilized. Few have examined RC adoption and its outcomes at a large scale. The present study aimed to identify trends in utilization, outcomes, and factors associated with use of RC using a national cohort.
Methods: We used the 2005-2016 National Inpatient Sample (NIS), the largest all payer US database, to identify all patients undergoing inpatient cholecystectomy. Temporal trends were analyzed beyond 2008, as International Classification of Diseases procedure codes for robot assistance were not available prior. Temporal trends were assessed using the Wilcoxon rank-sum test, categorical variables analyzed using chi square, and independent predictors of robotic cholecystectomy (RC) were identified using multivariable logistic regression models.
Results:Of an estimated 4,742,770 patients undergoing cholecystectomy, 83% underwent LC, 0.7% RC and 16% open. Rates of RC increased dramatically from 0.01% in 2008 to 2.3% in 2016 (p<0.01). Compared to LC, RC patients were on average older (52 vs 51 years, p<0.01), had greater burden of comorbidities as measured by the Elixhauser index (2.2 vs 1.8, p<0.01), and were more likely to live in the Southern geographic region (47 vs 40%, p<0.01). Patients undergoing RC were more likely to be diagnosed with cholelithiasis (16 vs 8%, p<0.01), but less likely to have cholecystitis (76 vs 88%, p<0.01) or gallstone pancreatitis (13 vs 17%, p<0.01). Patients undergoing RC were also more likely to have had an elective admission (35 vs 16%, p<0.01). Length of stay was not significantly different between RC and LC (4.1 vs. 4.1 days, p = 0.78). Although mortality rates were similar, RC was associated with significantly higher complication rates (7% vs 4%, p<0.01), in particular gastrointestinal-related complications (4% vs 1%, p<0.01). Although RC was associated with increased hospitalization costs ($16.5 K vs $13.1 K, p<0.01), the cost difference between LC and RC narrowed during the study period. (Figure 1). On multivariable regression, independent predictors of RC included older age (AOR=2.01, p<0.01), higher Elixhauser index (AOR=1.62, P<0.01), and admission to a teaching hospital (AOR=2.76, p<0.01).
Conclusion:Using the largest national analysis of RC, we observe dramatic rise in the use of this procedure accompanied by a relative reduction in cost difference between LC and RC. Increased complication rates in RC may be related to surgical experience and warrants further exploration.
