Laparoscopic cholecystectomy has reached nearly universal adoption in the management of gallstone-related disease. With advances in operative technology, robotic-assisted cholecystectomy has been used increasingly in many practices, but few studies have examined the adoption of robotic assistance for inpatient cholecystectomy and the temporal outcomes on a national scale. The present study aimed to identify trends in utilization, as well as outcomes and factors associated with the use of robotic-assisted cholecystectomy.
The 2008 to 2017 database of the National Inpatient Sample was used to identify patients undergoing inpatient cholecystectomy. Independent predictors of the use of robotic assistance for cholecystectomy were identified using multivariable logistic regression adjusting for patient and hospital characteristics.
Of an estimated 3,193,697 patients undergoing cholecystectomy, 98.7% underwent laparoscopic cholecystectomy and 1.3% robotic-assisted cholecystectomy. Rates of robotic-assisted cholecystectomy increased from 0.02% in 2008 to 3.2% in 2017 (nptrend < .001). Compared with laparoscopic cholecystectomy, patients undergoing robotic-assisted cholecystectomy had a greater burden of comorbidities as measured by the Elixhauser index (2.2 vs 1.9, P < .001). Although mortality rates were similar, robotic-assisted cholecystectomy was associated with greater complication rates (15.5% vs 11.7%, P < .001), most notably gastrointestinal-related complications (3.7% vs 1.5%, P < .001). On multivariable regression, robotic-assisted cholecystectomy was associated with increased costs of hospitalization (β: $2,398, P < .001).
Using the largest national database available, we found a dramatic increase in the use of robotic-assisted cholecystectomy with no difference in mortality or duration of hospital stay, but there was a statistically significant increase in complications and costs. These findings warrant further investigation.
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- Twenty years of laparoscopic cholecystectomy: Philippe Mouret-March 17, 1987.J Soc Laparoendosc Surg. 2008; 12: 109-111
- Multivariate comparison of complications after laparoscopic cholecystectomy and open cholecystectomy.Ann Surg. 1995; 221: 381-386
- Comparison of laparoscopic cholecystectomy with open cholecystectomy in a single center.Am J Surg. 1993; 165: 459-465
- Robotic versus laparoscopic cholecystectomy inpatient analysis: does the end justify the means?.J Gastrointest Surg. 2014; 18: 2116-2122
- First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform.Surg Endosc. 2011; 25: 3566-3573
- Robotic cholecystectomy: learning curve, advantages, and limitations.J Surg Res. 2006; 136: 172-178
- Robotic-assisted versus laparoscopic cholecystectomy.Ann Surg. 2008; 247: 987-993
- Adherence to methodological standards in research using the National Inpatient Sample.JAMA. 2017; 318: 2011-2018
- Healthcare Cost and Utilization Project (HCUP). NIS description of data elements; 2018.https://www.hcup-us.ahrq.gov/db/nation/nis/nisdde.jspDate accessed: April 30, 2020
- Comorbidity measures for use with administrative data.Med Care. 1998; 36: 8-27
- Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos).J Hepatobiliary Pancreat Sci. 2018; 25: 41-54
- Percutaneous cholecystostomy for grade III acute cholecystitis is associated with worse outcomes.Am J Surg. 2020; 220: 197-202
- Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies.Stat Med. 2015; 34: 3661-3679
- Robotic approach to cholecystectomy.in: Abdeldayem H. Updates in Gallbladder Diseases. InTech, London2017
- Use, costs and comparative effectiveness of robotic assisted, laparoscopic and open urological surgery.J Urol. 2012; 187: 1392-1398
- Use, cost, complications, and mortality of robotic versus nonrobotic general surgery procedures based on a nationwide database.Am Surg. 2013; 79: 553-560
- Robotic gastrointestinal surgery: early experience and system description.J Laparoendosc Adv Surg Tech A. 2002; 12: 225-232
- Single-site robotic cholecystectomy (SSRC) versus single-incision laparoscopic cholecystectomy (SILC): comparison of learning curves. First European experience.Surg Endosc. 2012; 26: 1648-1655
- Diffusion of robotic-assisted laparoscopic technology across specialties: a national study from 2008 to 2013.Surg Endosc. 2018; 32: 1405-1413
- Minimally invasive surgery: national trends in adoption and future directions for hospital strategy.Surg Endosc. 2013; 27: 2253-2257
- Cost analysis of robotic versus laparoscopic general surgery procedures.Surg Endosc. 2017; 31: 185-192
- New technology and health care costs–The case of robot-assisted surgery.N Engl J Med. 2010; 363: 701-704
- Single-site robotic cholecystectomy: efficiency and cost analysis.Int J Med Robot. 2013; 9: 365-370
Published online: August 03, 2020
Accepted: June 9, 2020
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