Robotic Foregut Surgery in the Veterans Health Administration: Increasing Prevalence, Decreasing Operative Time, and Improving Outcomes

Authors

Michael A. Napolitano, From the Department of Surgery, George Washington University, Washington, DC (Napolitano, Zebley, Wagner, Holleran, Werba, Sparks, Brody).
James A. Zebley, From the Department of Surgery, George Washington University, Washington, DC (Napolitano, Zebley, Wagner, Holleran, Werba, Sparks, Brody).
Kelly Wagner, From the Department of Surgery, George Washington University, Washington, DC (Napolitano, Zebley, Wagner, Holleran, Werba, Sparks, Brody).
Timothy J. Holleran, From the Department of Surgery, George Washington University, Washington, DC (Napolitano, Zebley, Wagner, Holleran, Werba, Sparks, Brody).
Gregor Werba, From the Department of Surgery, George Washington University, Washington, DC (Napolitano, Zebley, Wagner, Holleran, Werba, Sparks, Brody).
Andrew D. Sparks, From the Department of Surgery, George Washington University, Washington, DC (Napolitano, Zebley, Wagner, Holleran, Werba, Sparks, Brody).
Gregory Trachiotis, the Division of Cardiothoracic Surgery and Heart Center, Washington DC Veterans Affairs Medical Center, Washington, DC (Trachiotis).
Fred Brody, From the Department of Surgery, George Washington University, Washington, DC (Napolitano, Zebley, Wagner, Holleran, Werba, Sparks, Brody).

Document Type

Journal Article

Publication Date

8-1-2022

Journal

Journal of the American College of Surgeons

Volume

235

Issue

2

DOI

10.1097/XCS.0000000000000218

Abstract

BACKGROUND: Historically, robotic surgery incurs longer operative times, higher costs, and nonsuperior outcomes compared with laparoscopic surgery. However, in areas of limited visibility and decreased accessibility such as the gastroesophageal junction, robotic platforms may improve visualization and facilitate dissection. This study compares 30-day outcomes between robotic-assisted foregut surgery (RAF) and laparoscopic-assisted foregut surgery in the Veterans Health Administration. STUDY DESIGN: This is a retrospective review of the Veterans Affairs Quality Improvement Program database. Patients undergoing laparoscopic-assisted foregut surgery and RAF were identified using CPT codes 43280, 43281, 43282, and robotic modifier S2900. Multivariable logistic regression and multivariable generalized linear models were used to analyze the independent association between surgical approach and outcomes of interest. RESULTS: A total of 9,355 veterans underwent minimally invasive fundoplication from 2008 to 2019. RAF was used in 5,392 cases (57.6%): 1.63% of cases in 2008 to 83.41% of cases in 2019. After adjusting for confounding covariates, relative to laparoscopic-assisted foregut surgery, RAF was significantly associated with decreased adjusted odds of pulmonary complications (adjusted odds ratio [aOR] 0.44, p < 0.001), acute renal failure (aOR 0.14, p = 0.046), venous thromboembolism (aOR 0.44, p = 0.009) and increased odds of infectious complications (aOR 1.60, p = 0.017). RAF was associated with an adjusted mean ± SD of 29 ± 2-minute shorter operative time (332 minutes vs 361 minutes; p < 0.001). CONCLUSIONS: Veterans undergoing RAF ascertained shorter operative times and reduced complications vs laparoscopy. As surgeons use the robotic platform, clinical outcomes and operative times continue to improve, particularly in operations where extra articulation in confined spaces is required.

APA Citation

Napolitano, Michael A.; Zebley, James A.; Wagner, Kelly; Holleran, Timothy J.; Werba, Gregor; Sparks, Andrew D.; Trachiotis, Gregory; and Brody, Fred, "Robotic Foregut Surgery in the Veterans Health Administration: Increasing Prevalence, Decreasing Operative Time, and Improving Outcomes" (2022). GW Authored Works. Paper 1545.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1545

Department

Surgery