Accessibility to surgical robot technology and prostate-cancer patient behavior for prostatectomy
Accessibility to surgical robot technology and prostate-cancer patient behavior for prostatectomy
复制标题
DOI：
10.1093/jjco/hyx052
复制
发表时间：
2017-07
影响因子：
2.4
通讯作者：
T. Sugihara;H. Yasunaga;H. Matsui;Go Nagao;A. Ishikawa;T. Fujimura;H. Fukuhara;K. Fushimi;M. Ohori;Y. Homma
中科院分区：
文献类型：
--
作者：
T. Sugihara;H. Yasunaga;H. Matsui;Go Nagao;A. Ishikawa;T. Fujimura;H. Fukuhara;K. Fushimi;M. Ohori;Y. Homma
研究手术机器人的出现如何影响前列腺癌患者寻求根治性前列腺切除术的行为，重点是地理可及性。在日本，机器人手术于2012年4月获得批准。根据2012年4月至2014年3月期间日本诊断程序组合数据库中的数据，计算了个体根治性前列腺切除术的距离最近的手术机器人的距离和根治性前列腺切除术的间隔天数（除以2011年的平均间隔：根治性前列腺切除术的间隔天数%）非机器人医院的根治性前列腺切除术病例。病例量的变化，最近的手术机器人和机器人介绍的距离进行了调查。通过多变量分析评估根治性直肠癌切除术的间隔天数%的变化，包括与最近的手术机器人的距离、年龄、合并症、医院容量、手术类型、医院学术状况、床位容量和时间进展。结果机器人距离最近的距离<30 km时，根治术间隔天数%增加。当手术机器人出现在30公里和10公里范围内时，非机器人医院的乳房切除手术量在6个月内分别减少了13%和18%，而机器人医院的病例量增加了101%多变量分析，包括483例非机器人微创根治性切除术中的9759例开放性和5052例非机器人微创根治性切除术，机器人医院揭示了距离最近的手术机器人和根治性直肠癌切除术的间隔天数%之间的显着负相关（B =-17.3%，距离最近的手术机器人≥ 30 km，10 - 30 km与距离最近的手术机器人<10 km相比为-11.7%），而年龄较小，大容量医院、开放性手术提供者和时间进展是与根治性手术扩大间隔天数%相关的其他重要因素（均P <0.05）。结论30 km范围内机器人手术的可达性会降低患者选择传统手术的可能性。机器人离得越近，案件减少的速度就越快。
Background To examine how surgical robot emergence affects prostate-cancer patient behavior in seeking radical prostatectomy focusing on geographical accessibility. Methods In Japan, robotic surgery was approved in April 2012. Based on data in the Japanese Diagnosis Procedure Combination database between April 2012 and March 2014, distance to nearest surgical robot and interval days to radical prostatectomy (divided by mean interval in 2011: % interval days to radical prostatectomy) were calculated for individual radical prostatectomy cases at non-robotic hospitals. Caseload changes regarding distance to nearest surgical robot and robot introduction were investigated. Change in % interval days to radical prostatectomy was evaluated by multivariate analysis including distance to nearest surgical robot, age, comorbidity, hospital volume, operation type, hospital academic status, bed volume and temporal progress. Results % Interval days to radical prostatectomy became wider for distance to nearest surgical robot <30 km. When a surgical robot emerged within 30 and 10 km, the prostatectomy caseload in non-robot hospitals reduced by 13 and 18% within 6 months, respectively, while the robot hospitals gained +101% caseload (P < 0.01 for all) Multivariate analyses including 9759 open and 5052 non-robotic minimally invasive radical prostatectomies in 483 non-robot hospitals revealed a significant inverse association between distance to nearest surgical robot and % interval days to radical prostatectomy (B = -17.3% for distance to nearest surgical robot ≥30 km and -11.7% for 10-30 km versus distance to nearest surgical robot <10 km), while younger age, high-volume hospital, open-prostatectomy provider and temporal progress were other significant factors related to % interval days to radical prostatectomy widening (P < 0.05 for all). Conclusions Robotic surgery accessibility within 30 km would make patients less likely select conventional surgery. The nearer a robot was, the faster the caseload reduction was.