Robotic-Assisted vs Laparoscopic Bariatric Surgery and 30-Day Serious Adverse Events: A National MBSAQIP Analysis.

Abstract

Background: Robotic platforms are widely adopted in bariatric surgery, but whether they improve short-term safety in already standardized, low-morbidity operations remains uncertain.

Study design: We performed a retrospective cohort study of 949,507 adults undergoing minimally invasive sleeve gastrectomy, Roux-en-Y gastric bypass, or duodenal switch or single-anastomosis duodenoileal bypass with sleeve gastrectomy at MBSAQIP-accredited US centers from 2020 to 2024. Robotic-assisted laparoscopy (291,483) was compared with conventional laparoscopy (658,024). The primary endpoint was 30-day composite serious adverse events. Anatomy-stratified, conversion-aware multivariable logistic regression with robust SEs and marginal standardization estimated adjusted absolute risk differences.

Results: After adjustment for patient demographics, comorbidities, operative year, and conversion status, robotic assistance was associated with higher 30-day serious adverse event risk across procedure types and operative contexts. Adjusted excess risk ranged from 2.4 events per 1,000 primary sleeve gastrectomy cases (95% CI 1.5 to 3.4) to 15.2 events per 1,000 primary duodenal switch or single-anastomosis duodenoileal bypass with sleeve gastrectomy cases (95% CI 5.3 to 25.1). Excess risk was higher in conversion than primary operations for sleeve gastrectomy and Roux-en-Y gastric bypass. Component analysis showed differences distributed across multiple event types, predominantly readmission, reoperation, and reintervention; mortality was rare and similar between platforms. Adjusted excess risk attenuated over time, but the platform-by-year interaction was NS (p = 0.20).

Conclusions: In this national MBSAQIP cohort, robotic-assisted bariatric surgery was not associated with improved 30-day patient safety and was associated with small adjusted excess serious adverse event risk. Prospective studies incorporating surgeon- and center-level data are needed before short-term safety benefit is attributed to robotic adoption.