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Who Benefits from Robotic Cholecystectomy in Acute Care Surgery? A Comorbidity-Stratified Analysis
Zeynep Bilgili1, Alexander Chacon1, Sofia Ines Volpi1, Anupamaa Jan. Seshadri1, Charles Cook1, Daniel Peter. Bent, Jr.1, Alok Gupta1, Stephen Odom1, Maria Ferreira1,Amy Wyrzykowski1, Gabriel Brat1, CharlesParsons1, 1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Background: Robotic surgery is increasingly used in acute care surgery (ACS), but the patients most likely to benefit remain unclear. We compared outcomes of robotic versus laparoscopic cholecystectomy, focusing on high-risk patients. Methods: We retrospectively reviewed acute cholecystectomies performed at a single academic center (June 2024–2025). High-risk was defined as ASA ≥3, CCI ≥3, or age ≥65. Outcomes included conversion to open, subtotal cholecystectomy, length of stay (LOS), 30-day readmission, and hospital charges. Multivariable regression adjusted for age, sex, BMI, ASA, and CCI, with stratified and sensitivity analyses excluding cirrhotic patients. Results: Among 313 patients (181 laparoscopic, 132 robotic), 225 (71.9%) were high-risk. Robotic surgery was associated with lower odds of conversion to open (OR 0.27, p=0.07); after excluding cirrhotic patients, conversion was significantly lower (1.6% vs 6.4%, p=0.049). Although subtotal cholecystectomy was more frequent with robotics (8.3% vs 5.5%), the combined rate of conversion or subtotal cholecystectomy was similar (10.6% vs 11.0%). All conversions occurred in high-risk patients. Across all high-risk subgroups, robotic surgery showed consistent trends toward lower conversion and shorter LOS, with the greatest LOS reduction among patients ≥65 years (−3.41 days). Readmission rates were similar, while robotic cases had higher median hospital charges (+$3,632, p<0.001). Conclusions: Robotic cholecystectomy achieved outcomes comparable to laparoscopy overall but demonstrated consistent trends toward lower conversion and shorter LOS in high-risk patients. Despite higher hospital charges, robotics may provide the greatest benefit in medically complex ACS patients. Larger studies are needed to define optimal patient selection.
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