Robotic versus laparoscopic ileal pouch-anal anastomosis for ulcerative colitis: an analysis of the Nationwide readmission database, 2016–2020

Abstract Background Minimally invasive ileal pouch-anal anastomosis (IPAA), including laparoscopic and robotic-assisted approaches, has been shown to improve outcomes for ulcerative colitis (UC), but few studies have compared outcomes between robotic-assisted and conventional laparoscopic IPAA. This study aimed to evaluate short-term outcomes of robotic-assisted versus laparoscopic IPAA. Methods This retrospective cohort study utilized the U.S. Nationwide Readmission Database from 2016 to 2020. Patients aged ≥ 18 years undergoing robotic or laparoscopic IPAA for UC were included. Outcomes measured were in-hospital mortality, length of stay (LOS), hospital costs, complications, and 30-day and 90-day readmission rates. Propensity score matching (PSM) was employed to balance baseline characteristics, and multivariable regression was applied for adjusted analyses. Results Among 820 patients with UC undergoing IPAA, 242 robot-assisted and 242 laparoscopic cases were matched after PSM. Baseline demographic and clinical characteristics were well balanced following PSM. Robotic-assisted IPAA was associated with higher total hospital costs compared with the laparoscopic approach (adjusted mean difference, 24,460 USD; 95% CI 7.69–41.24; p = 0.004). No significant differences were observed between groups in LOS, overall postoperative complications, or 30- and 90-day readmission rates. Conclusion In this nationwide analysis, robotic-assisted IPAA was associated with higher hospital costs but comparable short-term clinical outcomes relative to laparoscopy. These findings suggest that while robotic IPAA is feasible and safe, its higher cost without clear short-term clinical benefit warrants careful consideration when selecting the surgical approach.