No Safety Advantage to Emergency Robotic Cholecystectomy
In acute care settings, robotic-assisted cholecystectomy (RAC) and laparoscopic cholecystectomy (LC) resulted in similar rates of bile duct injury, but RAC was associated with higher rates of major postoperative complications, more frequent drain placement, and longer hospital stays than LC.
METHODOLOGY:
Although some prior studies have raised concerns about increased bile duct injury with RAC vs LC, their relative safety in acute care surgery remains unclear.
Researchers conducted a retrospective cohort analysis using commercial claims and encounter data from 2016 to 2021 to compare outcomes between RAC and LC in acute care surgery.
The primary outcome was bile duct injury; secondary outcomes included major postoperative complications, the use of a postoperative drain, length of hospital stay, surgical site infections, and conversion to open surgery.
TAKEAWAY:
Researchers included 844,428 adults (mean age, 45.6 years; 64.9% women), with 35,037 undergoing RAC and being propensity-matched with an equal number of adults who underwent LC.
Adoption of RAC increased from 2.2% in 2016 to 8.2% in 2021.
Bile duct injury rates were similar between the groups (P = .54).
RAC vs LC was associated with higher rates of major postoperative complications (8.37% vs 5.50%; P < .001), an increased use of postoperative drains (0.63% vs 0.48%; P < .001), and a longer median hospital stay (3 vs 2 days; P < .001).
Use of intraoperative cholangiograms was more common in the LC than in the RAC group (P < .001), whereas RAC was associated with fewer surgical site infections than LC (0.04% vs 0.09%; P = .02).
Conversion to open surgery was uncommon in both the groups.
IN PRACTICE:
'Although these results may partly reflect case complexity and selection bias, they do not suggest a clear advantage of RAC over the standard, established laparoscopic cholecystectomy,' the authors wrote.
SOURCE:
The study was led by Nathnael Abera Woldehana, MD, MPH, Division of Minimally Invasive Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore. It was published online in JAMA Surgery.
LIMITATIONS:
The retrospective design may have introduced selection bias and unmeasured confounding factors. The study's generalizability is limited to commercially insured populations. Long-term outcomes such as readmissions, quality of life, and cost-effectiveness were not assessed.
DISCLOSURES:
Some authors reported receiving conference travel/attendance support, consulting fees, grants, advisory board fees, and speaker fees and having other ties with several organizations and pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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