Real-World Impact of Minimally Invasive Versus Open Radical Cystectomy on Perioperative Outcomes and Spending.
Real-World Impact of Minimally Invasive Versus Open Radical Cystectomy on Perioperative Outcomes and Spending.
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最小侵入性与开放式膀胱切除术对围手术期和支出的实际影响。
DOI：
10.1016/j.urology.2018.10.022
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发表时间：
2019-03
期刊：
影响因子：
2.1
通讯作者：
Ellimoottil C
中科院分区：
文献类型：
--
作者：
Modi PK;Hollenbeck BK;Oerline M;Weizer AZ;Montgomery JS;Kaffenberger SD;Ryan AM;Ellimoottil C
评价微创方法对膀胱癌根治术患者的费用和围手术期结局的影响。在高容量中心进行的一项随机对照试验中，机器人和开放式Cyberspace显示出相似的结局。然而，由于大多数膀胱切除术是在低容量中心进行的，因此尚不清楚这些发现是否具有广泛的普遍性。我们确定了在2008年至2015年期间接受膀胱癌根治术的医疗保险患者。我们研究了微创或开放性膀胱切除术后的住院时间、再入院率和90天的花费。我们使用多元回归来估计微创手术和结果之间的关联，考虑可能影响这些结果的患者，医院和外科医生因素。在4760例患者中，693例（14.6%）接受了微创手术，4,067例（85.4%）接受了开放手术。微创膀胱切除术与住院时间较短相关（10.1天vs11.9天，P<0.001），但再入院率无差异（27.4% vs26.8%，P=0.77）。微创膀胱镜检查与较低的调整后90天发作费用相关（34，369美元vs 38，071美元，P<0.001）。在美国不同机构的患者中，微创膀胱术与开放式膀胱术相比住院时间更短，并减少了90天的发作费用，但再入院率无显著差异。
To evaluate the effect of the minimally invasive approach on spending and perioperative outcomes for patients undergoing radical cystectomy for bladder cancer. In a randomized control trial conducted at high volume centers, robotic and open cystectomy were shown to have similar outcomes. However, because the majority of cystectomies are performed in low-volume centers, it is unknown whether these findings are broadly generalizable. We identified Medicare patients who underwent radical cystectomy for bladder cancer between 2008 and 2015. We examined the length of stay, readmission rate, and 90-day spending after minimally invasive or open cystectomy. We used multiple regression to estimate the association between minimally invasive surgery and the outcomes, accounting for patient, hospital, and surgeon factors that may influence these outcomes. Of 4760 patients, 693 (14.6%) underwent minimally invasive cystectomy and 4,067 (85.4%) had an open approach. Minimally invasive cystectomy was associated with shorter length of stay (10.1 days v 11.9 days, P<0.001), but no difference in readmission rate (27.4% v 26.8%, P=0.77). Minimally invasive cystectomy was associated with lower adjusted 90-day episode spending ($34,369 v $38,071, P<0.001). In patients across diverse institutions in the United States, minimally invasive cystectomy was associated with a shorter length of stay than open cystectomy and reduced 90-day episode spending, but with no significant difference in readmission rate.
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影响因子：
2.1
作者：
Pak, Jamie S.;Lee, Jason J.;Palese, Michael A.
通讯作者：
Palese, Michael A.
DOI：
10.1016/j.urolonc.2014.04.007
发表时间：
2014-08-01
影响因子：
2.7
作者：
Monn, M. Francesca;Cary, K. Clint;Koch, Michael O.
通讯作者：
Koch, Michael O.
影响因子：
23.4
作者：
Hu, Jim C.;Chughtai, Bilal;Sedrakyan, Art
通讯作者：
Sedrakyan, Art
影响因子：
120.7
作者：
Jeong, In Gab;Khandwala, Yash S.;Chung, Benjamin I.
通讯作者：
Chung, Benjamin I.
影响因子：
23.4
作者：
Nix, Jeff;Smith, Angela;Pruthi, Raj S.
通讯作者：
Pruthi, Raj S.