Inpatient Opioid Utilization After Robot-assisted versus Laparoscopic Bariatric Surgery

Introduction: Robotic platforms are increasingly utilized in bariatric surgery to overcome technical limitations of traditional laparoscopy. However, the impact of robotics on postoperative pain control is not fully understood. The present study aimed to compare pain control outcomes following primary bariatric surgery performed via robot-assisted approaches versus conventional laparoscopy. Methods: This was an IRB-approved retrospective investigation of all adults who underwent primary bariatric surgeries at a single institution from August 2016 to January 2019. Multivariable generalized linear and ordinal logistic regression models were fitted to test predictive associations of the (robotic vs laparoscopic) surgical technique with post-operative, in-hospital opioids consumption and pain intensity ratings, independent of co-varying risk factors. Results : A total of 340 patients (201 undergoing robotic, 139 laparoscopic procedures) were included in the study. Baseline preoperative characteristics were similar between comparison groups, except mean BMI was significantly higher among robotic surgery recipients (47.7 vs 44.0 kg/m ² ; p<0.001). Postoperative in-hospital opioid consumption did not significantly differ among recipients of robotic versus laparoscopic bariatric surgery. No difference was detected between comparison cohorts in total inpatient opioid use (p=0.300), opioid use in PACU (p=0.977), nor average opioid use per inpatient day (p=0.178). Similarly, in multivariable ordinal logistic regression models of postoperative day 0 and postoperative day 1 pain ratings, perceived pain intensity was not significantly higher following robotic versus laparoscopic primary bariatric surgeries, after accounting for other risk factors. Conclusion : Compared to conventional laparoscopy, robotic primary bariatric procedures did not independently increase post-operative, in-hospital opioid utilization nor pain intensity.