A new study published in JAMA Surgery suggests patients who have robot-assisted abdominal surgery (RAS) are more likely to have postoperative pulmonary complications (PPCs) than those who undergo conventional laparoscopic abdominal surgery (CLS). However, the cause is not the procedure approach, but rather the longer period of mechanical ventilation.
The goal of the study, “Postoperative Pulmonary Complications in Conventional Laparoscopic vs. Robot-Assisted Abdominal Surgery,” was to compare the rate of PPCs in RAS and CLS cases and to identify patient, procedure and anesthesia factors related to these complications. Researchers used multivariable mixed-effects logistic regression models to analyze data from two multicenter observational studies, LAS VEGAS and AVATaR, conducted between January 2013 and March 2019.
The study evaluated 2,738 patients (median age, 56 years; 53.1% female), of which 903 had RAS and 1,835 had CLS. Within the first five days of surgery, 19% of RAS patients experienced complications compared to 9.5% of CLS patients. Those in the RAS group also endured a longer length of stay in the hospital.
Comparing RAS cases to CLS cases, researchers observed a higher intensity of mechanical ventilation (median, 84 vs. 82) and a significantly longer duration of intraoperative ventilation (median, 219 vs. 95). According to the authors, “only the duration of ventilation rather than intensity of ventilation or type of surgical approach (i.e., RAS vs. CLS) was independently associated with the occurrence of PPCs, indicating that the longer duration of ventilation in RAS underlies the higher incidence of PPCs observed in those who undergo this type of surgery.”
The study’s limitations, including a lack of pooled data, warrant additional research to further investigate the effects certain surgical ventilation strategies have on PPCs. Additionally, researchers recommend assessing if possible long-term improved outcomes of RAS offset the increased short-term risk of PPCs.
