Robotic Use, Operative Length, and Readmission after Duodenal Switch: A Retrospective Ten-Year MBSAQIP Analysis Using an Interaction Model

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Abstract Background Robotic-assisted surgery (RAS) is increasingly used in bariatric practice, yet its impact on outcomes after duodenal switch (DS) remains poorly characterized, and whether operative length (OL) modifies the RAS-outcome association has not been assessed. The present study examines the independent and interactive effects of RAS and OL on 30-day readmission after DS using a national cohort of over 17,000 cases from the MBSAQIP database spanning 2015–2024. Methods We analyzed MBSAQIP data from 2015 to 2024 for patients undergoing laparoscopic DS (CPT 43845), excluding open, endoscopic, hand-assisted, and single-incision, revision, and conversion cases. Multivariable logistic regression assessed predictors of 30-day readmission, with a pre-specified interaction term between RAS and standardized OL to isolate the independent contribution of robotic use. Results Among 17,615 DS cases, 5,496 (31.2%) were robotic-assisted. Thirty-day readmission was higher after RAS than laparoscopic DS (6.2% vs. 5.0%, p < 0.01). In adjusted models, RAS (OR 1.78, 95% CI 1.25–2.55, p < 0.05) and OL (OR 1.27 per standard deviation (SD), 95% CI 1.18–1.38, p < 0.001) were independently associated with increased odds of readmission. The RAS–OL interaction significantly improved model fit (likelihood ratio p = 0.007); each SD decrease in OL increased the relative readmission risk for RAS versus laparoscopic cases (interaction OR 0.79, 95% CI 0.67–0.94, p < 0.05). Temporal subgroup analysis shows this disadvantage was concentrated in 2015–2019. Conclusions RAS for DS is associated with higher 30-day readmission, and OL significantly modifies this relationship. The interaction term suggests that improved operative efficiency will not resolve the RAS readmission disadvantage.