The First National Examination of Outcomes and Trends in Robotic Surgery in the United States
The First National Examination of Outcomes and Trends in Robotic Surgery in the United States
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DOI：
10.1016/j.jamcollsurg.2012.02.005
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发表时间：
2012-07-01
影响因子：
5.2
通讯作者：
Talamini, Mark A.
中科院分区：
文献类型：
--
作者：
Anderson, Jamie E.;Chang, David C.;Talamini, Mark A.
背景：很少有基于人群的数据描述机器人辅助手术的结局。我们比较了机器人辅助，腹腔镜，开放手术在全国代表性的人口database.Study设计：从2008年10月至2009年12月的全国住院病人样本数据库进行回顾性分析。我们通过ICD-9程序代码确定了最常见的机器人程序，并按程序类型将其分类。多变量分析检查了死亡率、住院时间（LOS）和总住院费用，调整了年龄、种族、性别、Charlson合并症指数和教学医院状态。在校正分析中，与开放手术相比，机器人辅助腹腔镜手术与死亡率降低相关（比值比= 0.1; 95% CI，0.0-0.2; p < 0.001），平均LOS降低（-2.4天; 95% CI，-2.5至2.3; p < 0.001），所有手术的平均总费用增加（范围3，852美元至15，329美元），冠状动脉旁路移植术（-17，318美元; 95% CI，-34，492至- 143; p = 0.048）和瓣膜成形术（无统计学意义）除外。与腹腔镜相比，机器人辅助腹腔镜手术的死亡率降低（比值比= 0.1; 95% CI，0.0 - 0.6; p = 0.008），总体LOS降低（-0.6天; 95% CI，-0.7至-0.5; p < 0.001），但在膀胱切除术和其他肾脏/膀胱手术中增加了LOS（0.3天; 95% CI，0.1-0.4; p = 0.006; 0.8天; 95% CI，0.0-1.6; p = 0.049），总费用增加（1，309美元; 95%CI，519- 2，099; p = 0.001）。数据表明，与开放手术相比，机器人辅助手术可降低LOS和死亡可能性。然而，当比较机器人辅助腹腔镜与非机器人腹腔镜手术时，这些益处并不明显。（美国科尔外科杂志2012; 215：107-116。(C)2012年美国外科医生学会）
BACKGROUND: There are few population-based data describing outcomes of robotic-assisted surgery. We compared outcomes of robotic-assisted, laparoscopic, and open surgery in a nationally representative population database.STUDY DESIGN: A retrospective analysis of the Nationwide Inpatient Sample database from October 2008 to December 2009 was performed. We identified the most common robotic procedures by ICD-9 procedure codes and grouped them into categories by procedure type. Multivariate analyses examined mortality, length of stay (LOS), and total hospital charges, adjusting for age, race, sex, Charlson comorbidity index, and teaching hospital status.RESULTS: A total of 368,239 patients were identified. On adjusted analysis, compared with open, robotic-assisted laparoscopic surgery was associated with decreased odds of mortality (odds ratio = 0.1; 95% CI, 0.0-0.2; p < 0.001), decreased mean LOS (- 2.4 days; 95% CI, - 2.5 to 2.3; p < 0.001), and increased mean total charges in all procedures (range $ 3,852 to $ 15,329) except coronary artery bypass grafting (- $ 17,318; 95% CI, - 34,492 to - 143; p = 0.048) and valvuloplasty (not statistically significant). Compared with laparoscopic, robotic-assisted laparoscopic surgery was associated with decreased odds of mortality (odds ratio = 0.1; 95% CI, 0.0 - 0.6; p = 0.008), decreased LOS overall (- 0.6 days; 95% CI, - 0.7 to - 0.5; p < 0.001), but increased LOS in prostatectomy and other kidney/bladder procedures (0.3 days; 95% CI, 0.1-0.4; p = 0.006; 0.8 days; 95% CI, 0.0-1.6; p = 0.049), and increased total charges ($ 1,309; 95% CI, 519-2,099; p = 0.001).CONCLUSIONS: Data suggest that, compared with open surgery, robotic-assisted surgery results in decreased LOS and diminished likelihood of death. However, these benefits are not as apparent when comparing robotic-assisted laparoscopic with nonrobotic laparoscopic procedures. (J Am Coll Surg 2012; 215: 107-116. (C) 2012 by the American College of Surgeons)