Robotic Emergency Surgery Linked to Fewer Severe Complications in Older Adults

A retrospective analysis of 58,940 patients aged 65 years or older in the ACS-NSQIP database compared robotic, laparoscopic and open emergency or urgent abdominal surgery. Robotic procedures were associated with fewer severe complications and more frequent discharge home, although the observational design cannot establish that the surgical approach caused these differences.

Analysis included 58,940 older emergency-surgery patients.
Robotic surgery was associated with fewer severe complications.
Adjusted analysis found no difference in operative time or length of stay.
Retrospective findings cannot establish causality.

Older adults undergoing emergency general surgery may have increased risks related to frailty and comorbidities. Researchers retrospectively analyzed ACS-NSQIP data from 2022–2023 for 58,940 patients aged 65 or older who underwent urgent or emergent intra-abdominal surgery: 1,832 robotic, 30,137 laparoscopic and 26,971 open procedures. The primary outcome was severe complications; secondary outcomes included length of stay, discharge disposition and readmission.

Compared with laparoscopic and open surgery, robotic procedures had lower conversion rates (6.2% vs 12.9% for laparoscopy) and shorter unadjusted stays (4 days for robotic and laparoscopic procedures vs 8 days for open surgery). After propensity matching, robotic patients had higher ASA scores and more transfusions but lower reported rates of sepsis (2.6% vs 6.5%) and mortality (2.3% vs 2.7%) than laparoscopic patients. In multivariable analysis, robotic surgery was associated with lower risk of severe complications (p=0.025) and greater likelihood of discharge home; operative time and length of stay did not differ.

These findings suggest robotic surgery may be a feasible option for selected older patients, but they do not show that it is superior. The retrospective, nonrandomized comparison is vulnerable to residual confounding, and the authors report associations rather than causal effects. The study received no funding, and the authors disclosed no financial ties.

In practice

For older adults undergoing urgent or emergent intra-abdominal surgery, this large retrospective database analysis found robotic surgery was associated with fewer severe complications and greater likelihood of discharge home than comparator approaches in adjusted analyses. These findings may inform discussion of operative approach, but they do not establish that robotics improves outcomes: treatment was not randomized, and residual differences between patients and procedures may explain the associations. The results do not justify changing practice on their own.

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Source

Surgical Endoscopy: Robotic emergency surgery in geriatric care ↗

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