Background

SADI is an endorsed Metabolic and Bariatric Surgery (MBS) procedure. It was suggested that the Robotic Assisted (RA-) approach can improve the outcomes of SADI compared to more common procedures like RA-SG and RA-RYGB. However, the outcomes of RA-SADI compared to those procedures are largely unknown. Objective: To compare the 30-day outcomes of RA-SADI to RA-SG and RA-RYGB based on MBSAQIP. Setting: Retrospective study using national clinical database.

Methods

Data was extracted from the MBSAQIP database for 2020-2022 resulting in 513,191 patients. Exclusion criteria included prior foregut or bariatric surgery and lack of 30-day follow-up. The cohort included 634 RA-SADI so we randomly selected 10:1 ratio RA-SG (6,330) and RA-RYGB (6,330) to compare outcomes. Our primary outcomes included Serious Event Occurrence (SEO) a composite score, and intervention at 30-days. Secondary outcomes included hospital length of stay and readmission.

Results

RA-SADI was associated with higher rates of SEO and intervention at 30-days compared to RA-SG (RR 3.11 and 1.58 respectively, p<0.05). However, difference between RA-SADI and RA-RYGB was not significant (RR 1.15 and 0.79 respectively p>0.05). RA-SADI was also associated with longer hospital stay compared to RA-SG and RA-RYGB (RR 1.86 and 1.22 respectively, p<0.05). Readmission rate was also higher following RA-SADI compared to RA-SG (RR 1.98, p<0.05) but not compared to RA-RYGB. RA-SADI also had a longer operative time compared to both RA-SG and RA-RYGB (RR 0.62 and 0.09 respectively, p<0.05).

Conclusions

Postoperative complications following RA-SADI appear to be higher compared to RA-SG but similar to RA-RYGB.