Cost-effectiveness and outcomes of robot-assisted vs laparoscopic bariatric procedures in super obese patients: a propensity score matching analysis from a high- volume center

Abstract

Abstract The increased operative time and costs represent the main limitations of robotic technology application to bariatric surgery. Robotic platforms may help surgeon to overcome the technical difficulties in super obese (SO, BMI ≥ 50 kg/m2) patients, in which multiquadrant operations could be challenging. We aimed to evaluate the effect of robot-assisted (R) versus laparoscopic (L) approach in SADI-S and RYGB in SO and Super-Super Obese (SSO, BMI ≥ 60 kg/m2) patients in terms of cost-effectiveness and outcomes. Bariatric procedures performed from 2012 to 2022 were retrospectively reviewed. The inclusion criteria were BMI ≥ 50 kg/m2, primary SADI-S or RYGB. Operative time (OT), early complications, postoperative stay (POS), overall costs and follow-up data were analyzed. A subgroup analysis for surgical procedures and SSO patients was also performed. Among 4139 patients, 170 RYGB and 87 SADI-S in BMI ≥ 50 kg/m2 patients were selected. After Propensity Score Matching analysis, two groups of patients were identified (laparoscopic and robot-assisted), each one composed by 16 RYGB and 24 SADI-S. Intraoperative and postoperative complications rates and POS were comparable. Mean OT was longer in robot-assisted procedures compared with laparoscopy (198.3 ± 66.1 and 107.1 ± 38.2 minutes, respectively, p < 0.001). The difference in OT was eliminated after only SSO patients were included in the analysis (172.7 ± 24.1 vs 152.6 ± 26.2 minutes for R-SADI-S and L-SADI-S, respectively, p = 0.107). Robotic surgeries were associated with higher costs (8147.6 ± 2157.7€ and 2427.8 ± 487.3€ in R-RYGB and L-RYGB, respectively; 8057.6 ± 1883.1€ and 3968.6 ± 724.1€ in R-SADI-S and L-SADI-S). Despite increased costs, robot-assisted approach may represent an added value in more complex cases such as SSO patients.