Safety, efficacy, and cost-effectiveness of common laparoscopic procedures
Safety, efficacy, and cost-effectiveness of common laparoscopic procedures
复制标题
常见腹腔镜手术的安全性、有效性和成本效益
DOI：
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发表时间：
2011
期刊：
影响因子：
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通讯作者：
D. Oleynikov
中科院分区：
文献类型：
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作者：
M. M. Tiwari;J. Reynoso;R. High;Albert W. Tsang;D. Oleynikov
研究背景在大多数腹部外科手术中，腹腔镜术可提供更好的手术效果。然而，几乎没有任何证据表明手术结果与患者风险分层有关。方法使用大学卫生系统联盟(UHC)临床数据库/资源管理器(CDB/RM)对6种常见外科手术的手术结果进行回顾性分析，这些手术包括胆囊切除术、阑尾切除术、反流手术、胃旁路手术、腹股沟疝修补术和结肠切除术。对6种常见的腹腔镜手术的3年出院数据进行分析，包括观察死亡率、患者总体发病率、重症监护病房(ICU)入院情况、30天再入院时间、住院时间和住院费用。结果在本研究中，208,314名患者接受了6种常见手术方式中的一种，即开腹手术或腹腔镜手术。总体而言，腹腔镜方法显示死亡率显著降低，发病率降低，ICU入院和30天再住院次数减少，住院时间缩短，所有手术的住院费用显著降低。根据疾病严重程度分层，在所有疾病严重程度组中，腹腔镜组显示出更好或相似的手术结果。然而，在大多数手术中，在腹腔镜手术和开腹手术之间，观察到的死亡率对于轻度和中度严重的患者是相似的。在大多数外科手术中，重度/极重度患者的30天再住院率在两组之间具有可比性。结论在所有疾病严重程度风险组中，在普通外科手术中，腹腔镜术优于传统开腹手术。结果表明，与开腹手术相比，腹腔镜术是安全、有效和经济的，并提示无论病情严重程度如何，腹腔镜术都应该是所有常见外科手术的首选手术方式。
BackgroundLaparoscopic surgery has been shown to offer superior surgical outcomes for most abdominal surgical procedures. However, there is hardly any evidence on surgical outcomes with patient risk stratification. This study aimed to compare outcomes of common laparoscopic and open surgical procedures for varying illness severity.MethodsA retrospective analysis of surgical outcomes for six commonly performed surgical procedures including cholecystectomy, appendectomy, reflux surgery, gastric bypass surgery, ventral hernia repair, and colectomy was performed using the University HealthSystem Consortium (UHC) Clinical Database/Resource Manager (CDB/RM). The 3-year discharge data for the six commonly performed laparoscopic surgical procedures were analyzed for outcome measures including observed mortality, overall patient morbidity, intensive care unit (ICU) admissions, 30-day readmissions, length of hospital stay, and hospital costs.ResultsIn this study, 208,314 patients underwent one of six common surgical procedures by either the open or the laparoscopic approach. Overall, the laparoscopic approach showed significantly lower mortality, reduced morbidity, fewer ICU admissions and 30-day readmissions, shorter hospital stay, and significantly reduced hospital costs for all the procedures. At stratification by illness severity, the laparoscopic group showed better or comparable surgical outcomes across all the illness severity groups. However, the observed mortality was comparable for the minor and moderate severity patients between laparoscopic and open surgery for most procedures. The 30-day readmission rate for major/extreme severity patients was comparable between the two groups for most surgical procedures.ConclusionsThis study demonstrated the superiority of laparoscopy over conventional open surgery across all illness severity risk groups for common surgical procedures. The results in general show that laparoscopic surgery is safe, efficacious, and cost-effective compared with open surgery and suggest that laparoscopic surgery should be the procedure of choice for all common surgical procedures, regardless of illness severity.
影响因子：
120.7
作者：
Weeks, JC;Nelson, H;Schroeder, G
通讯作者：
Schroeder, G