Age disparity in robotic colorectal surgery: overcoming surgeon hesitancy to improve elderly patient outcomes

Background: Robotic colorectal surgery offers significant benefits for vulnerable elderly patients, but its adoption in this demographic appears limited. We hypothesized that a significant age-related disparity exists in robotic surgery utilization. This study aimed to investigate the relationship between age and the use of robotic surgery, along with its associated postoperative outcomes in elderly patients. Methods: This retrospective cohort study utilized the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2021. We analyzed 80,187 patients aged 65 years or older undergoing elective colectomy or proctectomy. The primary endpoint was the utilization of the robotic surgical approach. Key secondary endpoints included in-hospital mortality, medical and surgical complications, and length of hospital stay. Results: Older age was independently associated with a decreased likelihood of undergoing robotic surgery (OR 0.98, 95% CI 0.97–0.98; p < 0.001). Compared to open and laparoscopic approaches, robotic surgery was associated with significantly lower odds of in-hospital mortality (OR 0.709, 95% CI 0.578–0.870; p = 0.001), medical complications (OR 0.790, 95% CI 0.723–0.863; p < 0.001), and surgical complications (OR 0.713, 95% CI 0.669–0.759; p < 0.001). The robotic approach was also associated with a shorter length of hospital stay (OR 0.819, 95% CI 0.804–0.834; p < 0.001). Conclusion: A significant age-related disparity exists in the use of robotic colorectal surgery. Elderly patients are less likely to undergo this procedure despite its association with improved postoperative outcomes. Overcoming surgeon hesitancy and systemic barriers is necessary to ensure older adults have equitable access to the benefits of advanced surgical technologies.