Procedure-specific outcomes of robotic versus laparoscopic Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch across a decade of MBSAQIP adoption

Robotic adoption in metabolic and bariatric surgery has increased, but its procedure-specific short-term outcomes remain uncertain. This study compared robotic and laparoscopic Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD-DS) over a decade. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was queried for primary RYGB and BPD-DS performed from 2015 to 2024. Missing data were addressed using multiple imputation followed by stabilized inverse probability of treatment weighting. Propensity-score and outcome models were fitted separately within four predefined procedure-period strata: RYGB 2015-2019, RYGB 2020-2024, BPD-DS 2015-2019, and BPD-DS 2020-2024. Thirty-day outcomes were estimated within each stratum, with Benjamini-Hochberg false-discovery-rate adjustment applied across the modeled comparisons. The analysis included 411,155 patients: 87,028 R-RYGB, 307,420 L-RYGB, 5,283 R-BPD-DS, and 11,424 L-BPD-DS. Robotic utilization increased from 8.6% to 44.0% for RYGB and from 28.2% to 50.3% for BPD-DS. For RYGB, the robotic approach was associated with higher readmission in both periods (OR 1.23 and 1.19), lower odds of serious complications (OR 0.84 and 0.87), and longer operative duration (mean differences 39.83 and 26.17 min). For BPD-DS, robotic surgery was associated with higher readmission in both periods (OR 1.38 and 1.25), higher intervention in 2015-2019 (OR 1.65), and longer operative duration (mean differences 87.49 and 40.85 min). BPD-DS estimates were less precise, and some associations attenuated in the complete-case sensitivity analysis. Robotic utilization increased substantially but was associated with longer operative duration and higher readmission for both procedures, without a clear overall 30-day safety advantage. BPD-DS findings were less precise and should be considered exploratory.