Utilization Trends and Short-term Outcomes of Robotic Versus Open Radical Cystectomy for Bladder Cancer
Utilization Trends and Short-term Outcomes of Robotic Versus Open Radical Cystectomy for Bladder Cancer
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DOI：
10.1016/j.urology.2016.10.067
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发表时间：
2017-05-01
期刊：
影响因子：
2.1
通讯作者：
Palese, Michael A.
中科院分区：
文献类型：
--
作者：
Pak, Jamie S.;Lee, Jason J.;Palese, Michael A.
目的比较自引入机器人改良器以来，机器人与开放式膀胱癌根治术的使用趋势和短期结局（ICD-917.4x）.材料和方法使用全州规划和研究合作系统数据库，一个关于纽约州所有医院出院的所有付款人管理系统，我们确定了2008年10月至2012年12月接受根治性膀胱切除术（57.71）并诊断为膀胱癌（188.0-188.9，233.7，236.7）的患者。主要结局是住院并发症和指示住院时的死亡率。结果在2525名患者中，24.2%（2525名中的610名）接受了机器人手术，75.8%（2525名中的1915名）接受了开放式根治性膀胱切除术。机器人病例的比例从2009年的19.9%（597例中的119例）增加到2012年的28.9%（598例中的173例）（P <0.05）。从2009年到2012年，开放式外科医生的数量从117人减少到109人，机器人从56人增加到66人。机器人患者的入路特异性外科医生和医院容量较低，更有可能接受淋巴结清扫术、回肠导管分流术、输血和延长住院时间。在多变量分析中，机器人方法降低了输血的风险（比值比：0.600，95%置信区间：0.492-0.732，P <0.0005），但与住院时间延长无关。在住院并发症或死亡率、肠外营养、住院时间、住院费用、90天内的再入院率或90天内的死亡率方面，两种手术方法之间没有显著差异。我们报道了较低的输血率和其他类似的开放根治性膀胱术的短期结果。(C)2017爱思唯尔公司
OBJECTIVE To compare utilization trends and short-term outcomes of robotic versus open radical cystectomy for bladder cancer since the introduction of the robotic modifier (ICD-9 17.4x).MATERIALS AND METHODS Using the Statewide Planning and Research Cooperative System database, an all-payer administrative system on all hospital discharges in New York State, we identified patients undergoing radical cystectomy (57.71) with a diagnosis of bladder cancer (188.0-188.9, 233.7, 236.7) from October 2008 to December 2012. Primary outcomes were inpatient complications and mortality at index stay.RESULTS Of the 2525 patients, 24.2% (610 of 2525) underwent robotic and 75.8% (1915 of 2525) underwent open radical cystectomy. The proportion of robotic cases increased from 19.9% (119 of 597) in 2009 to 28.9% (173 of 598) in 2012 (P < .05). From 2009 to 2012, the number of open surgeons decreased from 117 to 109, and that of robotic increased from 56 to 66. Robotic patients had lower approach-specific surgeon and hospital volume, and more likely underwent lymph node dissection, ileal conduit diversion, blood transfusion, and prolonged length of stay. On multivariate analysis, robotic approach conferred a reduced risk of blood transfusion (odds ratio: 0.600, 95% confidence interval: 0.492-0.732, P < .0005) but had no association with prolonged length of stay. There were no significant differences in inpatient complications or mortality at index stay, parenteral nutrition, length of stay, hospital charges, readmission rates up to 90 days, or mortality up to 90 days between the surgical approaches.CONCLUSION Despite the rapid dissemination and more recent experience of robotic radical cystectomy, we report lower rates of blood transfusion and otherwise similar short-term outcomes with open radical cystectomy. (C) 2017 Elsevier Inc.