Abstract:
Background: Bariatric surgery plays a key role in the definitive treatment of Obesity and the use of the daVinci robotic platform has been well integrated into the field. While meta analyses of the outcomes of patients who had undergone robotic bariatric surgery have been performed for over 10 years, they do not include studies with large patient populations. The goal of this paper is to increase the robustness of future meta analysis studies of the field by providing demographic and outcomes statistics of a large pool of robotic patients, and to suggest preoperative and continuum of care protocol enhancements based on trends derived from the published data.
Results: 18,906 total encounters of 1,457 operative patients were analyzed, averaging 13 visits per patient including 2.5 weight submissions through the practice’s online portal. Males were a minority with 77.6% of the patients being female. On average, males underwent surgery significantly later in life when compared to females (45.2 vs 50.2, p<0.05). Average presenting BMI was 44.92. Average patient retention is 443 days, reduced to 431 days when excluding online portal weight checks (p=0.22). Average male retention is 458 days post surgery, and average female retention is 439 days (p=0.28). 22 patients did not present for any follow up encounters. Analysis of patient loss to follow up showed double percentage digit declines after the one year milestone. BMI trend analysis showed a flatlining and ultimate reversal of weight loss around the second and fourth year, respectively. 2,217 non-operative patients were also analyzed separately.
Conclusions: There does not appear to be a criteria where the assistance of the robotic platform in bariatric surgery significantly changes patient outcomes, however the results derived from our patient pool largely align with published trends and should enhance further studies. The use of an online portal for weight checks was a useful tool to track patients even if they did not meet with office staff. Since males tend to undergo bariatric surgery later in life with higher severity of illness yet only account for a quarter of patients, there is a seemingly apparent necessity for increasing awareness among males that bariatric surgery is a viable option for treating obesity, and identifying reasons for this gender discrepancy warrants further study. Based on the evident dropoff in follow up percentages aligning with flatlining and ultimate reversal of BMI reduction over time, we recommend considering innovation in the protocols for postoperative patient management.
