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Background <p>Robotic pancreaticoduodenectomy (RPD) is increasingly performed in the United States. Understanding factors associated with safe adoption of RPD is critical to reducing perioperative mortality during the learning curve.</p> Methods <p>Using the Epic Cosmos database, the study identified adult patients (age ≥18&#xa0;years) who underwent pancreaticoduodenectomy (PD) between 2019 and 2025. Modified Poisson regression was used to assess factors associated with 30-day mortality using adjustment for age, sex, race, ethnicity, insurance, marital status, rural/urban residence, socioeconomic status, and diagnosis. Among surgeons performing two or more RPDs, mortality trends were analyzed across case-number thresholds. Mortality risk was assessed by cumulative RPD and open PD (OPD) experience, with adjustment for age and diagnosis.</p> Results <p>Among 23,995 patients with a median age of 69 years (interquartile range [IQR], 62–75 years), 1578 (6.6 %) underwent RPD. Use of RPD increased from 4% of PD in 2019 to 10% in 2025. The 30-day mortality was higher for RPD than for OPD (2.7 % vs 2.0 %; adjusted relative risks [aRR], 1.43 (IQR, 1.02–1.95; <i>p</i> = 0.029). In RPD, mortality decreased with increasing surgeon prior experience: 3.9 % (Q1: 0–1 cases), 3.9 % (Q2: 2–4 cases), 2.22 % (Q3: 5–8 cases), 2.67 % (Q4: 9–18 cases), 0.92 % (Q5: 19–71 cases). Increased RPD experience was associated with decreased mortality (per doubling RPD experience: aRR, 0.78 (95 % confidence interval [CI], 0.63–0.96; <i>p</i> = 0.02). The patients who underwent PD between 2023 and 2025 showed no adjusted increase in mortality with robotic technique (aRR, 1.04; 95 % CI, 0.61–1.65; <i>p</i> = 0.85).</p> Conclusions <p>Nationwide, adoption of RPD is associated with increased 30-day mortality, which decreases substantially with increasing surgeon RPD experience. These findings suggest that structured, competency-based training pathways are needed to ensure safe dissemination of novel technology, including RPD.</p>

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Increased Mortality with Surgeon Adoption of Robotic Pancreaticoduodenectomy: A National EHR Study of Outcomes

  • 期刊论文

  • 发表日期：

    2026年5月22日

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  • Conor B. Donnelly,
  • Greg D. Sacks,
  • D. Brock Hewitt,
  • Michal Mankowski,
  • Sommer E. Gentry,
  • Dorry L. Segev,
  • Allan B. Massie

摘要

Background

Robotic pancreaticoduodenectomy (RPD) is increasingly performed in the United States. Understanding factors associated with safe adoption of RPD is critical to reducing perioperative mortality during the learning curve.

Methods

Using the Epic Cosmos database, the study identified adult patients (age ≥18 years) who underwent pancreaticoduodenectomy (PD) between 2019 and 2025. Modified Poisson regression was used to assess factors associated with 30-day mortality using adjustment for age, sex, race, ethnicity, insurance, marital status, rural/urban residence, socioeconomic status, and diagnosis. Among surgeons performing two or more RPDs, mortality trends were analyzed across case-number thresholds. Mortality risk was assessed by cumulative RPD and open PD (OPD) experience, with adjustment for age and diagnosis.

Results

Among 23,995 patients with a median age of 69 years (interquartile range [IQR], 62–75 years), 1578 (6.6 %) underwent RPD. Use of RPD increased from 4% of PD in 2019 to 10% in 2025. The 30-day mortality was higher for RPD than for OPD (2.7 % vs 2.0 %; adjusted relative risks [aRR], 1.43 (IQR, 1.02–1.95; p = 0.029). In RPD, mortality decreased with increasing surgeon prior experience: 3.9 % (Q1: 0–1 cases), 3.9 % (Q2: 2–4 cases), 2.22 % (Q3: 5–8 cases), 2.67 % (Q4: 9–18 cases), 0.92 % (Q5: 19–71 cases). Increased RPD experience was associated with decreased mortality (per doubling RPD experience: aRR, 0.78 (95 % confidence interval [CI], 0.63–0.96; p = 0.02). The patients who underwent PD between 2023 and 2025 showed no adjusted increase in mortality with robotic technique (aRR, 1.04; 95 % CI, 0.61–1.65; p = 0.85).

Conclusions

Nationwide, adoption of RPD is associated with increased 30-day mortality, which decreases substantially with increasing surgeon RPD experience. These findings suggest that structured, competency-based training pathways are needed to ensure safe dissemination of novel technology, including RPD.