Departments of Anesthesiology and Pain Management and Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.
Obstet Gynecol. 2013 Oct;122(4):778-786. doi: 10.1097/AOG.0b013e3182a4ee4d.
Use of robotically assisted hysterectomy for benign gynecologic conditions is increasing. Using the most recent, available nationwide data, we examined clinical outcomes, safety, and cost of robotic compared with laparoscopic hysterectomy.
Women undergoing robotic or laparoscopic hysterectomy for benign disease were identified from the United States 2009 and 2010 Nationwide Inpatient Sample. Propensity scores derived from a logistic regression model were used to assemble matched cohorts of patients undergoing robotic and laparoscopic hysterectomy. Differences in in-hospital complications, hospital length of stay, and hospital charges were assessed between the matched groups.
Of the 804,551 hysterectomies for benign conditions performed in 2009 and 2010, 20.6% were laparoscopic and 5.1% robotically assisted. Among minimally invasive hysterectomies, the use of robotic hysterectomy increased from 9.5% to 13.6% (P=.002). In a propensity-matched analysis, the overall complication rates were similar between robotic and laparoscopic hysterectomy (8.80% compared with 8.85%, relative risk 0.99, 95% confidence interval [CI] 0.89-1.09, P=.910). There was a lower incidence of blood transfusions in robotic cases (2.1% compared with 3.1%; P<.001), but patients undergoing robotic hysterectomy were more likely to experience postoperative pneumonia (relative risk 2.2, 95% CI 1.24-3.78, P=.005). The median cost of hospital care was $9,788 (interquartile range $7,105-12,780) for robotic hysterectomy and $7,299 (interquartile range $5,650-9,583) for laparoscopic hysterectomy (P<.001). Hospital costs were on average $2,489 (95% CI $2,313-2,664) higher for patients undergoing robotic hysterectomy.
The use of robotic hysterectomy has increased. Perioperative outcomes are similar between laparoscopic and robotic hysterectomy, but robotic cases cost substantially more.
: II.
机器人辅助子宫切除术用于良性妇科疾病的应用正在增加。利用最新的全国性数据，我们检查了机器人辅助与腹腔镜子宫切除术的临床结果、安全性和成本。
从美国 2009 年和 2010 年全国住院患者样本中确定了因良性疾病接受机器人或腹腔镜子宫切除术的患者。使用逻辑回归模型得出的倾向评分用于组装接受机器人和腹腔镜子宫切除术的患者匹配队列。评估匹配组之间住院并发症、住院时间和住院费用的差异。
在 2009 年和 2010 年进行的 804551 例良性疾病子宫切除术，20.6%为腹腔镜，5.1%为机器人辅助。在微创手术中，机器人子宫切除术的使用率从 9.5%增加到 13.6%（P=.002）。在倾向评分匹配分析中，机器人和腹腔镜子宫切除术的总体并发症发生率相似（8.80%与 8.85%，相对风险 0.99，95%置信区间 [CI] 0.89-1.09，P=.910）。机器人手术中输血的发生率较低（2.1%与 3.1%；P<.001），但机器人子宫切除术患者更有可能发生术后肺炎（相对风险 2.2，95%CI 1.24-3.78，P=.005）。机器人子宫切除术的住院治疗中位费用为 9788 美元（四分位距 [IQR] 7105-12780），腹腔镜子宫切除术为 7299 美元（IQR 5650-9583）（P<.001）。机器人子宫切除术患者的平均住院费用平均高出 2489 美元（95%CI 2313-2664）。
机器人子宫切除术的应用有所增加。腹腔镜和机器人子宫切除术的围手术期结果相似，但机器人手术的成本要高得多。
II。
