Robotic surgery for emergency general surgery is used less frequently in transferred patients, showing significant hospital-level variation with comparable clinical outcomes to other techniques.

• Robotic surgery was utilized in only 8.5% of transfer-receiving hospitals, highlighting its limited adoption.
• Compared to laparoscopy, robotic surgery offered a shorter length of stay (LOS) but at a higher cost, with no significant difference in outcomes.
• In comparison to open surgery, robotic approaches also resulted in a shorter LOS and lower complication rates, but were linked with a higher frequency of non-home discharges.

This study suggests a need for clearer selection criteria and evaluation of access to robotic surgery in emergency settings.