{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T14:29:54Z","timestamp":1793111394335,"version":"4.5.0"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Robotic-assisted surgery is increasingly used in acute care surgery, but the impact of individual surgeon robotic case volume on outcomes for both elective and emergency general surgery procedures remains uncertain.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the association between annual surgeon robotic case volume and patient outcomes following robotic-assisted elective and emergency general surgery.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study used data from the Premier Healthcare Database (PHD), a large US all-payer hospital database, from January 2021 to December 2023. The PHD aggregates data from nonprofit, community, and teaching hospitals across rural and urban areas, representing 25% of all US inpatient admissions. Adult patients (aged \u226518 years) undergoing robotic-assisted cholecystectomy, colectomy, appendectomy, small bowel resection, or ventral hernia repair were included.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Annual surgeon-level robotic case volume, categorized as low (\u226425), intermediate (26-75), high (76-150), or very high (\u2265151).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was conversion to open surgery; secondary outcomes included postoperative complications, intensive care unit (ICU) admission, 30-day readmission, operative time, hospital length of stay, total hospital cost, and in-hospital mortality. Multivariable logistic and linear regression models, respectively, were used to estimate adjusted odds ratios (AORs) and mean ratios with 95% CIs. Models adjusted for patient demographics, hospital characteristics, and surgeon specialty.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 185\u202f924 patients undergoing robotic procedures (137\u202f879 elective and 48\u202f045 emergency), most (58.2%) were female (57.1% of elective and 61.5% of emergency cases). Mean (SD) patient age was 54.9 (16.6) years overall (55.6 [15.8] years for elective and 53.0 [18.5] years for emergency procedures). In elective procedures, increasing annual surgeon volume was associated with stepwise improvements across most outcomes; compared with low volume surgeons, very high volume surgeons had lower odds of conversion to open surgery (AOR, 0.45; 95% CI, 0.36-0.56), complications (AOR, 0.87; 95% CI, 0.79-0.96), readmission (AOR, 0.79; 95% CI, 0.68-0.91), and ICU admission (AOR, 0.61; 95% CI, 0.46-0.82). Operative time (mean ratio, 0.77; 95% CI, 0.75-0.79), hospital length of stay (mean ratio, 0.89; 95% CI, 0.88-0.91), and costs (mean ratio, 0.83; 95% CI, 0.82-0.84) were also significantly lower. In emergency procedures, very high vs low surgeon volume was associated with lower odds of conversion to open surgery (AOR, 0.73; 95% CI, 0.54-1.00) and modest reductions in operative time (mean ratio, 0.88; 95% CI, 0.85-0.91) and cost (mean ratio, 0.92; 95% CI, 0.89-0.94). No association was observed between surgeon volume and in-hospital mortality in either cohort.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study, greater annual surgeon robotic case volume was associated with better patient outcomes in elective general surgery and, to a lesser degree, in emergency procedures. These findings highlight the importance of surgeon-specific experience in robotic surgery and may inform training, credentialing, and strategies for safe expansion of robotic capabilities in acute care surgery.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.11774","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T15:30:46Z","timestamp":1778513446000},"page":"e2611774","source":"Crossref","is-referenced-by-count":2,"title":["Surgeon Volume and Clinical Outcomes After Robotic Elective and Emergency General Surgery"],"prefix":"10.1001","volume":"9","author":[{"given":"Natasha","family":"Houshmand","sequence":"first","affiliation":[{"name":"Department of Surgery, Johns Hopkins Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I-Fan","family":"Shih","sequence":"additional","affiliation":[{"name":"Global Access Value Economics, Intuitive Surgical, Sunnyvale, 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