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Background

Bariatric surgery is increasingly performed using a robotic approach. While robotic and laparoscopic approaches have been shown to have comparable peri-operative outcomes, the former is associated with longer operative times. We examine whether a longer operative time causes increased incidence of venous thromboembolic events (VTE) in matched robotic (RA) and laparoscopic (Lap) cohorts.

Methods

The 2020-2021 Participate User Files were reviewed retrospectively. Lap and RA sleeve gastrectomy and gastric bypasses (MBS) were included. Patients were propensity matched 1:1 based on method of VTE prophylaxis, procedure type, and other pre-operative variables. Logistic regression models of the matched cohorts were created to look at impact of operative time on VTE.

Results

285,738 patients were included in the study (79% laparoscopic, 21% robotic). No significant difference in VTE incidence between laparoscopic and robotic was seen in the unmatched cohorts (0.3% vs 0.4%, p = 0.253), with a trend towards increased VTE in the RA group. The propensity matched cohorts (58,958 in each) showed no difference in VTE (0.4% vs 0.3%, p = 0.589). After propensity score matching, operative time was associated with a significant increase in pulmonary embolism (PE) (OR 2.098, CI 1.552 – 2.837). Longer median operative times were seen in cases where a PE occurred in both RA and Lap MBS.

Conclusions

Increased operative time is associated with an increased incidence of PE in both RA and Lap MBS. The longer procedure times seen in RA-MBS may contribute to increased rates of PE relative to laparoscopic approaches.