This retrospective study compared clinical outcomes and cost between robotic cholecystectomy (RC) and laparoscopic cholecystectomy (LC) in 1,828 adult patients across 8 hospitals (2020–2021), stratified by Nassar preoperative difficulty score and BMI, with 90-day follow-up.
RC had a lower adverse outcome rate than LC (3.3% vs 8.7%; P < .001), with the greatest benefit in high-risk patients (Nassar ≥7) and those with elevated BMI (≥30–35). However, RC cost significantly more across all risk groups (~$2,200–$2,400 more per encounter). A validated risk calculator showed strong discrimination (AUC ~0.75).
Retrospective design limits causal inference. Study is confined to one health system, which may limit generalizability. Cost data reflect total variable cost per encounter and may not capture downstream costs or payer-specific differences.
Consider robotic cholecystectomy for high-risk patients (Nassar ≥7) and those with elevated BMI, where it meaningfully reduces adverse outcomes — but weigh this against ~$2,200–$2,400 higher procedural cost. Use a validated preoperative risk calculator to guide surgical approach selection.
