Robotic versus Laparoscopic Cholecystectomy in Emergency General Surgery: Do Older Adults Benefit More than Younger Adults?
Poster #: 095
Session/Time: B
Author:
William Miller Rice, BS
Mentor:
Jessica Burgess, MD
Research Type: Clinical Research
Abstract
INTRODUCTION:
Robotic surgery is becoming more prevalent in emergency general surgery (EGS), with evidence showing reductions in postoperative length of stay and conversion to open surgery. However, recent studies suggest that, unlike other EGS procedures, robotic surgery does not significantly reduce postoperative length of stay for cholecystectomy. With the aging EGS patient population, robotic surgery may be particularly helpful for improving outcomes in older adults, who often face elevated surgical risks and longer recoveries. We sought to better understand differences between older and younger adults in outcomes of robotic versus laparoscopic cholecystectomy in an EGS setting. We hypothesized that employing robotic surgery over laparoscopy would yield greater improvements in postoperative length of stay, operating room charges, readmission rates, and mortality for older adults compared to younger adults.
METHODS:
This retrospective cohort study compared older (≥65 years) to younger adults (18-64 years) who were urgently/emergently admitted between 2016-2020 to undergo cholecystectomy using the Virginia Health Information Patient Level Database. Propensity score matching (1:10 nearest neighbor) analyzed the association between robotic versus laparoscopic approach and the outcomes of postoperative length of stay, operating room charges, readmission, and mortality, stratifying by older versus younger adults. Controls included demographics, insurance, Social Deprivation Index (SDI), comorbidities, and operative approach. Effect sizes were reported as average treatment effects (ATE) with 95% confidence intervals. P-values <0.05 were considered significant.
RESULTS:
Among 22,286 patients, 8,144 (36.5%) were aged ≥65 years, with robotic surgery utilized in 3.5% of cases across both age groups. Among both older and younger adults, patients who underwent robotic cholecystectomy were more likely to be admitted emergently and experienced longer preoperative lengths of stay compared to those operated on laparoscopically. After propensity matching, robotic surgery in older adults was associated with a significantly shorter postoperative length of stay (ATE = -0.60 days, 95% CI -0.87- -0.32 days), whereas no significant reduction was observed in younger adults (ATE = -0.01 days, 95% CI -0.29-0.26 days). Robotic surgery was linked to higher operating room charges in both groups, with a greater increase among older adults (ATE = $15,825, 95% CI $13,059-$18,590) compared to younger adults (ATE = $10,597, 95% CI $8,674-$12,520). There was no association between robotic surgery and readmission rates in either group. However, robotic surgery was associated with reduced mortality in both older (ATE = -0.8%, 95% CI -1.0%- -0.6%) and younger adults (ATE = -0.1%, 95% CI -0.2%- -0.1%), with older adults experiencing a more pronounced benefit.
CONCLUSION:
Robotic cholecystectomy in EGS was associated with reduced postoperative length of stay and mortality among older adults, while also providing a significant, though smaller, mortality benefit in younger adults when compared with laparoscopy. However, these benefits were accompanied by higher operating room costs, especially for older adults. These findings build upon prior research by highlighting potential advantages specifically for older adults undergoing cholecystectomy in an EGS setting. While the potential for employing robotics in EGS is promising, efforts must focus on reducing costs and emphasizing clinical benefit to justify broader adoption of this emerging technology.
Robotic surgery is becoming more prevalent in emergency general surgery (EGS), with evidence showing reductions in postoperative length of stay and conversion to open surgery. However, recent studies suggest that, unlike other EGS procedures, robotic surgery does not significantly reduce postoperative length of stay for cholecystectomy. With the aging EGS patient population, robotic surgery may be particularly helpful for improving outcomes in older adults, who often face elevated surgical risks and longer recoveries. We sought to better understand differences between older and younger adults in outcomes of robotic versus laparoscopic cholecystectomy in an EGS setting. We hypothesized that employing robotic surgery over laparoscopy would yield greater improvements in postoperative length of stay, operating room charges, readmission rates, and mortality for older adults compared to younger adults.
METHODS:
This retrospective cohort study compared older (≥65 years) to younger adults (18-64 years) who were urgently/emergently admitted between 2016-2020 to undergo cholecystectomy using the Virginia Health Information Patient Level Database. Propensity score matching (1:10 nearest neighbor) analyzed the association between robotic versus laparoscopic approach and the outcomes of postoperative length of stay, operating room charges, readmission, and mortality, stratifying by older versus younger adults. Controls included demographics, insurance, Social Deprivation Index (SDI), comorbidities, and operative approach. Effect sizes were reported as average treatment effects (ATE) with 95% confidence intervals. P-values <0.05 were considered significant.
RESULTS:
Among 22,286 patients, 8,144 (36.5%) were aged ≥65 years, with robotic surgery utilized in 3.5% of cases across both age groups. Among both older and younger adults, patients who underwent robotic cholecystectomy were more likely to be admitted emergently and experienced longer preoperative lengths of stay compared to those operated on laparoscopically. After propensity matching, robotic surgery in older adults was associated with a significantly shorter postoperative length of stay (ATE = -0.60 days, 95% CI -0.87- -0.32 days), whereas no significant reduction was observed in younger adults (ATE = -0.01 days, 95% CI -0.29-0.26 days). Robotic surgery was linked to higher operating room charges in both groups, with a greater increase among older adults (ATE = $15,825, 95% CI $13,059-$18,590) compared to younger adults (ATE = $10,597, 95% CI $8,674-$12,520). There was no association between robotic surgery and readmission rates in either group. However, robotic surgery was associated with reduced mortality in both older (ATE = -0.8%, 95% CI -1.0%- -0.6%) and younger adults (ATE = -0.1%, 95% CI -0.2%- -0.1%), with older adults experiencing a more pronounced benefit.
CONCLUSION:
Robotic cholecystectomy in EGS was associated with reduced postoperative length of stay and mortality among older adults, while also providing a significant, though smaller, mortality benefit in younger adults when compared with laparoscopy. However, these benefits were accompanied by higher operating room costs, especially for older adults. These findings build upon prior research by highlighting potential advantages specifically for older adults undergoing cholecystectomy in an EGS setting. While the potential for employing robotics in EGS is promising, efforts must focus on reducing costs and emphasizing clinical benefit to justify broader adoption of this emerging technology.