In-Hospital Outcomes of Robotic-Assisted Cholecystectomy in Obese versus Normal-Weight Patients: A National Inpatient Sample Analysis

Introduction: Obesity increases perioperative risks in cholecystectomy due to its association with gallbladder disease.Robotic-assisted cholecystectomy (RC) may mitigate technical challenges in this population.This study compares in-hospital outcomes of RC between obese (BMI 30 kg/m 2 ) and normal-weight (BMI 18-25 kg/m 2 ) patients using National Inpatient Sample data.Methods: A retrospective analysis of National Inpatient Sample data (2016-2021) identified 15,048 adults undergoing RC.Patients were stratified into obese (n = 4570) and normalweight (n = 10,478) groups.Demographics, comorbidities, hospital characteristics, and in-hospital outcomes were analyzed using multivariable models.Results: Thirty percent of RC patients were obese.Obese individuals were younger than normal-weight patients (median 50 versus 57 y, P < 0.001) and had lower mortality (adjusted OR 0.27, 95% CI 0.10-0.60,P = 0.004) and infection rates (adjusted OR 0.33, 95% CI 0.09-0.89,P = 0.05), with no significant differences in other complications or open conversion.Conclusions: RC is increasingly performed in obese patients and appears safe in appropriately selected individuals.Despite higher comorbidity burdens, obese patients demonstrated lower in-hospital mortality and similar complication rates.Potential selection bias and lack of long-term outcome data warrant cautious interpretation.