AbuHasan Qais, Miller Payton M, Li Wendy S, Burney Charles P, Yuce Tarik K, Stefanidis Dimitrios
Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Surg Obes Relat Dis. 2025 Feb;21(2):158-165. doi: 10.1016/j.soard.2024.09.002. Epub 2024 Sep 16.
Robotic surgery utilization has been increasing across surgical specialties; however, racial disparities in patient access to care and outcomes have been reported.
In this study, we examined racial disparities in the utilization and outcomes of robotic bariatric surgery over an 8-year period.
Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) centers of excellence across the United States.
The MBSAQIP database was used to identify adult patients who underwent robotic bariatric surgery between 2015 and 2022. Patients were stratified according to race and ethnicity into non-Hispanic White, non-Hispanic Black or African American (AA), Indigenous, Asian, and Hispanic patients. Multivariable analyses were used to assess predictors of robotic surgery use, odds of minor and major complications, prolonged length of stay (prolonged length of stay (pLOS): ≥3 days), readmissions, reoperations, and mortality within 30 days.
Out of 1,288,359 patients included, robotic surgery was utilized in 196,314 patients (15.2%), with a mean age of 44 ± 12 years and 80.6% females. Rates of robotic surgery increased to 30% by 2022. Compared to White patients, Black/AA patients were more likely to undergo robotic surgery (adjusted odds ratio (aOR) = 1.22, 95% confidence interval (CI) = 1.21-1.24, P < .001). The safety of robotic bariatric surgery improved for both White and Black patients with decreased odds of major complications, readmissions, reoperations, and pLOS over the study period. However, Black/AA patients were more likely to experience minor and major complications, readmissions and have pLOS compared with White patients in 2022 (aOR:1.26, 95% CI:1.19-1.34, P < .001; aOR:1.22, 95% CI:1.06-1.41, P = .006; aOR:1.44, 95% CI:1.28-1.62, P < .001; aOR:2.26, 95% CI:2.06-2.47, P < .001, respectively).
The utilization of robotic bariatric surgery has increased significantly over the past 8 years with continued improvements in its safety profile. While Black/AA patients have improved access to robotic surgery, their clinical outcomes continue to be worse than those of White patients. Efforts to address racial disparities in bariatric surgery outcomes must remain a priority to achieve health equity.
机器人手术在各个外科专业中的应用一直在增加；然而，据报道，患者在获得医疗服务和治疗结果方面存在种族差异。
在本研究中，我们调查了8年间机器人减肥手术在应用和治疗结果方面的种族差异。
美国代谢与减肥手术认证质量改进计划（MBSAQIP）卓越中心。
使用MBSAQIP数据库识别2015年至2022年间接受机器人减肥手术的成年患者。患者按种族和族裔分为非西班牙裔白人、非西班牙裔黑人或非裔美国人（AA）、原住民、亚裔和西班牙裔患者。多变量分析用于评估机器人手术使用的预测因素、轻微和重大并发症的几率、住院时间延长（住院时间延长（pLOS）：≥3天）、再次入院、再次手术以及30天内的死亡率。
在纳入的1288359名患者中，196314名患者（15.2%）接受了机器人手术，平均年龄为44±12岁，女性占80.6%。到2022年，机器人手术的使用率提高到了30%。与白人患者相比，黑人/非裔美国人患者接受机器人手术的可能性更大（调整后的优势比（aOR）=1.22，95%置信区间（CI）=1.21-1.24，P<.001）。在研究期间，机器人减肥手术对白人患者和黑人患者的安全性均有所提高，重大并发症、再次入院、再次手术和住院时间延长的几率均有所降低。然而，2022年，与白人患者相比，黑人/非裔美国人患者更有可能出现轻微和重大并发症、再次入院，并且住院时间延长（aOR：1.26，95%CI：1.19-1.34，P<.001；aOR：1.22，95%CI：1.（此处原文有误，应为1.06-1.41），P=.006；aOR：1.44，95%CI：1.28-1.62，P<.001；aOR：2.26，95%CI：2.06-2.47，P<.001）。
在过去8年中，机器人减肥手术的应用显著增加，其安全性也在持续改善。虽然黑人/非裔美国人患者接受机器人手术的机会有所增加，但他们的临床结果仍然比白人患者差。解决减肥手术结果中的种族差异问题仍然是实现健康公平的优先事项。
