Population level assessment of hospital based outcomes following laparoscopic versus open partial nephrectomy during the adoption of minimally invasive surgery.
Population level assessment of hospital based outcomes following laparoscopic versus open partial nephrectomy during the adoption of minimally invasive surgery.
复制标题
在采用微创手术期间，对腹腔镜与开腹肾部分切除术后基于医院的结果进行人群水平评估。
DOI：
10.1016/j.juro.2013.11.002
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Miller,DavidC
中科院分区：
文献类型：
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作者：
Tan,Hung-Jui;WolfJr,JStuart;Ye,Zaojun;Hafez,KhaledS;Miller,DavidC
目的腹腔镜与开腹肾部分切除术的疗效比较尚无定论。因此，我们使用基于人群的数据来检查在腹腔镜和开腹肾部分切除术治疗肾癌患者之间的资源使用和短期结果。材料和方法使用链接的SEER(监测、流行病学和最终结果)-联邦医疗保险数据，我们确定了2000-2007年间接受腹腔镜或开腹肾部分切除术的肾癌患者。然后，我们使用医疗保险索赔来确定几个术后结果，包括重症监护病房护理、住院时间、再次住院、手术死亡率和术后并发症。我们建立多元Logistic回归模型，根据患者和肿瘤的特点，对每种手术方式(即腹腔镜肾部分切除术与开腹肾部分切除术)之间的相关性进行估计。结果我们确定了651例(28%)和1,670例(72%)接受腹腔镜肾部分切除术和开腹肾部分切除术的患者。与接受开腹肾部分切除术的患者相比，接受腹腔镜肾部分切除术的患者需要重症监护病房时间的概率低34%(20.0%比30.2%，p<；0.001)，中位住院时间更短(3天比5天，p<；0.001)，再住院的可能性和手术死亡率没有差异。术后并发症发生率相似(35.5%vs36.1%，P=0.829)，而接受腹腔镜肾部分切除术的患者发生泌尿生殖系统并发症和术后出血的几率几乎是对照组的两倍(p<；0.001)。结论在人群水平上，接受腹腔镜肾部分切除术的肾癌患者住院时间短、强度低，支持了腹腔镜手术的优点。然而，手术相关并发症的可能性更大，这表明需要继续努力，以确保这一先进外科技术的安全采用和应用。
PurposeThe comparative outcomes of laparoscopic and open partial nephrectomy remain incompletely defined. Therefore, we used population based data to examine resource use and short-term outcomes among patients with kidney cancer treated with laparoscopic vs open partial nephrectomy.Materials and MethodsUsing linked SEER (Surveillance, Epidemiology, and End Results)-Medicare data we identified patients with kidney cancer treated with laparoscopic or open partial nephrectomy from 2000 through 2007. We then used Medicare claims to identify several postoperative outcomes including intensive care unit care, length of stay, rehospitalizations, operative mortality and postoperative complications. We fit multivariate logistic regression models to estimate the association between each outcome and surgical approach (ie laparoscopic partial nephrectomy vs open partial nephrectomy), adjusting for patient and tumor characteristics.ResultsWe identified 651 (28%) and 1,670 (72%) patients treated with laparoscopic partial nephrectomy and open partial nephrectomy, respectively. Compared to those who underwent open partial nephrectomy, patients treated with laparoscopic partial nephrectomy had a 34% lower probability of requiring intensive care unit time (20.0% vs 30.2%, p <0.001) and shorter median length of stay (3 vs 5 days, p <0.001), with no differences observed in the likelihood of rehospitalization or operative mortality. While the frequency of postoperative complications was similar (35.5% vs 36.1%, p = 0.829), patients treated with laparoscopic partial nephrectomy had a nearly twofold greater probability of genitourinary complications and postoperative hemorrhage (p <0.001).ConclusionsAt a population level the patients with kidney cancer treated with laparoscopic partial nephrectomy experienced a shorter and less intense hospitalization, supporting the benefits of laparoscopy. However, the greater likelihood of procedure related complications highlights the need for continued efforts aimed at ensuring the safe adoption and application of this advanced surgical technique.