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Robotic Bariatric Surgery in Older Adults, Is It Safer Than the Laparoscopic Approach? A 7-Year Analysis of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database

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Abstract

Background

Utilization of the robotic platform in bariatric surgery has increased over the past several years. The population of older adults who benefit from bariatric surgery is also growing. This study evaluated the safety of robotic-assisted bariatric surgery in older adults using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database.

Methods

Adults who underwent gastric bypass or sleeve gastrectomy and were ≥ 65 years old between the years 2015 and 2021 were included. The 30-day outcomes were assessed and stratified based on Clavien-Dindo (CD) classification of III–V. Univariable and multivariable logistic regressions were performed to identify predictors of CD ≥ III complications.

Results

A total of 62,973 bariatric surgery patients were included. Most of the patients (90%) underwent laparoscopic surgery, and the remainder (10%) underwent robotic surgery. Robotic sleeve gastrectomy (R-SG) was associated with lower odds of develo** CD ≥ III complications compared to three other procedures (adjusted odds ratio (aOR), 0.741; confidence interval (CI), 0.584–0.941; p 0.014).

Conclusions

Bariatric surgery using a robotic approach is considered safe for older patients. Robotic sleeve gastrectomy (R-SG) has the lowest morbidity and mortality rates compared to laparoscopic sleeve gastrectomy (L-SG), laparoscopic Roux-en-Y gastric bypass (L-RYGB), and robotic Roux-en-Y gastric bypass (R-RYGB). The findings of this study can help surgeons and their elderly patients to make informed decisions regarding the safety of different bariatric surgical approaches.

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Authors and Affiliations

  1. Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, 1501N, Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA

    Ahmad Omid Rahimi, Yazan Ashouri, Felipe Maegawa & Iman Ghaderi

  2. Epidemiology and Biostatistics Department, University of Arizona College of Public Health, Tucson, AZ, USA

    Chiu-Hsieh Hsu

Authors
  1. Ahmad Omid Rahimi
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  2. Yazan Ashouri
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  3. Felipe Maegawa
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  5. Iman Ghaderi
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Corresponding author

Correspondence to Iman Ghaderi.

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Key Points

• Robotic approach in bariatric surgery is safe in older patients.

• Robotic sleeve gastrectomy had the lowest complication rate compared to laparoscopic sleeve gastrectomy, laparoscopic, or robotic gastric bypass in elderly population.

• Robotic sleeve gastrectomy may be considered as a preferred procedure in the older population in the absence of contraindications.

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Appendix

Appendix

Addendum. Clavien-Dindo Classification reclassified based on MBSAQIP variables [20].

figure b

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Rahimi, A.O., Ashouri, Y., Maegawa, F. et al. Robotic Bariatric Surgery in Older Adults, Is It Safer Than the Laparoscopic Approach? A 7-Year Analysis of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database. OBES SURG 33, 2671–2678 (2023). https://doi.org/10.1007/s11695-023-06720-1

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