机器人普通外科手术围手术期风险评估：来自单一机构884例病例的经验教训。
Perioperative risk assessment in robotic general surgery: lessons learned from 884 cases at a single institution.
作者信息
Buchs Nicolas C, Addeo Pietro, Bianco Francesco M, Gorodner Veronica, Ayloo Subhashini M, Elli Enrique F, Oberholzer José, Benedetti Enrico, Giulianotti Pier C
机构信息
Divisions of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
出版信息
Arch Surg. 2012 Aug;147(8):701-8. doi: 10.1001/archsurg.2012.496.
OBJECTIVE
To assess factors associated with morbidity and mortality following the use of robotics in general surgery.
DESIGN
Case series.
SETTING
University of Illinois at Chicago.
PATIENTS AND INTERVENTION
Eight hundred eighty-four consecutive patients who underwent a robotic procedure in our institution between April 2007 and July 2010.
MAIN OUTCOMES MEASURES
Perioperative morbidity and mortality.
RESULTS
During the study period, 884 patients underwent a robotic procedure. The conversion rate was 2%, the mortality rate was 0.5%, and the overall postoperative morbidity rate was 16.7%. The reoperation rate was 2.4%. Mean length of stay was 4.5 days (range, 0.2-113 days). In univariate analysis, several factors were associated with increased morbidity and included either patient-related (cardiovascular and renal comorbidities, American Society of Anesthesiologists score ≥ 3, body mass index [calculated as weight in kilograms divided by height in meters squared] <30, age ≥ 70 years, and malignant disease) or procedure-related (blood loss ≥ 500 mL, transfusion, multiquadrant operation, and advanced procedure) factors. In multivariate analysis, advanced procedure, multiquadrant surgery, malignant disease, body mass index of less than 30, hypertension, and transfusion were factors significantly associated with a higher risk for complications. American Society of Anesthesiologists score of 3 or greater, age 70 years or older, cardiovascular comorbidity, and blood loss of 500 mL or more were also associated with increased risk for mortality.
CONCLUSIONS
Use of the robotic approach for general surgery can be achieved safely with low morbidity and mortality. Several risk factors have been identified as independent causes for higher morbidity and mortality. These can be used to identify patients at risk before and during the surgery and, in the future, to develop a scoring system for the use of robotic general surgery
目的
评估普通外科使用机器人技术后与发病和死亡相关的因素。
设计
病例系列研究。
地点
伊利诺伊大学芝加哥分校。
患者与干预措施
2007年4月至2010年7月期间在本机构连续接受机器人手术的884例患者。
主要观察指标
围手术期发病率和死亡率。
结果
在研究期间，884例患者接受了机器人手术。转换率为2%，死亡率为0.5%，总体术后发病率为16.7%。再次手术率为2.4%。平均住院时间为4.5天（范围0.2 - 113天）。在单因素分析中，几个因素与发病率增加相关，包括患者相关因素（心血管和肾脏合并症、美国麻醉医师协会评分≥3、体重指数[按千克体重除以身高米的平方计算]<30、年龄≥70岁以及恶性疾病）或手术相关因素（失血≥500 mL、输血、多象限手术和复杂手术）。在多因素分析中，复杂手术、多象限手术、恶性疾病、体重指数小于30、高血压和输血是与并发症风险较高显著相关的因素。美国麻醉医师协会评分3分或更高、年龄70岁或以上、心血管合并症以及失血500 mL或更多也与死亡风险增加相关。
结论
普通外科使用机器人手术方法可安全实现，发病率和死亡率较低。已确定几个风险因素是发病率和死亡率较高的独立原因。这些因素可用于在手术前和手术期间识别有风险的患者，并在未来用于开发机器人普通外科手术的评分系统。
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