Design: Retrospective cohort study.

Setting: Inpatient and outpatient facilities included in the Merative™ database (US employer-based claims).

Patients or Participants: Individuals who had an endometriosis procedure from 2016 to 2020, whose insurance had prescription coverage, and had continuous enrollment from one year before to two years after their procedure (n = 22,683).

Interventions: Robotic and laparoscopic endometriosis procedure.

Measurements and Main Results: Opioid use was compared for those who had a laparoscopic endometriosis procedure and those who had a robotic-assisted endometriosis procedure in the pre-operative (1 year to 30 days before the procedure), perioperative (29 days before to 14 days after the procedure) and post-operative (15 days to 2 years after the procedure) periods. There was no significant difference in pre-operative opioid use between the two groups. Individuals who had a robotic assisted procedure had slightly higher odds of opioid use in the peri-operative period than those who had a laparoscopic procedure (OR = 1.20; 95% CI 1.01, 1.41); however, when adjusting for individual characteristics and complexity of procedure, this difference was no longer significant (OR = 1.14; 95% CI 0.96, 1.35). Individuals who had a robotic assisted procedure had significantly lower odds of opioid use in the post-operative period than those who had a laparoscopic procedure (OR =0.81; 95% CI 0.72, 0.90); these odds remained significant after adjustment for individual characteristics, complexity of procedure, and perioperative opioid use (OR = 0.87; 95% CI 0.77, 0.98).

Conclusion: Postoperative opioid use was significantly lower among individuals who had a robotic endometriosis procedure compared to those who had a laparoscopic endometriosis procedure.