Evaluating quality across minimally invasive platforms in colorectal surgery
Evaluating quality across minimally invasive platforms in colorectal surgery
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DOI：
10.1007/s00464-015-4479-0
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发表时间：
2016-06-01
影响因子：
3.1
通讯作者：
Haas, Eric M.
中科院分区：
文献类型：
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作者：
Keller, Deborah S.;Flores-Gonzalez, Juan R.;Haas, Eric M.
简介 人们越来越重视优化和测量手术质量。微创技术的安全性和有效性已得到证实；然而，尚未对跨平台的结果进行直接比较。我们的目标是比较结直肠手术中三个微创平台的手术时间和质量。方法回顾了 2008 年至 2014 年择期微创手术 (MIS) 病例的前瞻性数据库。将患者分为多孔腹腔镜手术、单切口腹腔镜手术 (SILS) 或机器人辅助腹腔镜手术 (RALS)。对人口统计学、围手术期和术后结果进行了分析。使用多元回归分析来预测与每个平台相关的人口统计和程序因素以及结果。主要结局指标是手术时间和入路手术质量。结果 总共评估了 1055 例病例，其中 LAP 为 28.4%，RALS 为 18.5%，SILS 为 53.1%。 RALS 的患者、病理和手术最为复杂。 RALS 的主要诊断是直肠癌 (49.5%)，患者主要接受盆腔手术 (72.8%)，新辅助放化疗 (p < 0.001) 和造口术 (p < 0.001) 的比例较高。 RALS 的手术时间最长，并发症和再入院率最高（均 p < 0.001）。多端口患者年龄大于 SILS 和 RALS (p = 0.021)，术中并发症最多 (p < 0.001)、中转 (p < 0.001)，住院时间最长 (p = 0.001)。 SILS 的手术时间最短 (p < 0.001)、住院时间最短 (p = 0.001)，并发症发生率 (p < 0.001)、再入院率 (p < 0.001) 和计划外再次手术率最低 (p = 0.014)。所有平台均提供高质量（HARM 评分 0），总体 LOS 短、再入院率和死亡率低。结论 Multiport、RALS 和 SILS 各自服务于不同的人口和疾病概况，并具有可预测的结果。所有这些都有风险和好处，但提供整体高质量的护理，包括 LOS、再入院率和死亡率。手术时间与再入院率直接相关。由于这三个平台都提供良好的质量，因此选择使用哪种 MIS 方法应以人口统计数据和疾病过程为指导。
Introduction There is an increasing emphasis on optimizing and measuring surgical quality. The safety and efficacy of minimally invasive techniques have been proven; however, direct comparison of outcomes across platforms has not been performed. Our goal was to compare operative times and quality across three minimally invasive platforms in colorectal surgery.Methods A prospective database was reviewed for elective minimally invasive surgery (MIS) cases from 2008 to 2014. Patients were stratified into multiport laparoscopic, single-incision laparoscopic (SILS) or robotic-assisted laparoscopic approaches (RALS). Demographics, perioperative, and postoperative outcomes were analyzed. Multivariate regression analysis was used to predict the demographic and procedural factors and outcomes associated with each platform. The main outcome measures were operative time and surgical quality by approach.Results A total of 1055 cases were evaluated-28.4 % LAP, 18.5 % RALS, and 53.1 % SILS. RALS had the most complex patients, pathology, and procedures. The main diagnosis for RALS was rectal cancer (49.5 %), patients predominantly underwent pelvic surgery (72.8 %), had higher rates of neoadjuvant chemoradiation (p < 0.001) and stoma creation (p < 0.001). RALS had the longest operative time and highest complication and readmissions rates (all p < 0.001). Multiport patients were older than SILS and RALS (p = 0.021), had the most intraoperative complications (p < 0.001), conversions (p < 0.001), and had the longest length of stay (p = 0.001). SILS had the shortest operative times (p < 0.001), length of stay (p = 0.001), and lowest rates of complications (p < 0.001), readmissions (p < 0.001), and unplanned reoperation (p = 0.014). All platforms offered high quality (HARM score 0) from overall short LOS, low readmission, and mortality rates.Conclusions Multiport, RALS, and SILS each serve a distinct demographic and disease profile and have predictable outcomes. All have risks and benefits, but offer overall high-quality care with a composite of LOS, readmission, and mortality rates. Operative times were directly associated with readmission rates. As all three platforms offer good quality, the choice of which MIS approach to use should be guided by demographics and disease process.