Department of Urology, UC San Diego Health System, San Diego, CA.
Department of Urology, UC San Diego Health System, San Diego, CA; Division of Urologic Oncology, UC San Diego Moores Cancer Center, La Jolla, CA; VA San Diego Healthcare System, San Diego, CA.
Urology. 2014 Aug;84(2):314-9. doi: 10.1016/j.urology.2014.02.048. Epub 2014 Jun 21.
To compare perioperative patient safety outcomes of minimally invasive cystectomy (MIC) with open cystectomy (OC) in a national cohort. Comparative outcomes data based on validated metrics are sparse for MIC, an emerging treatment for bladder cancer.
We identified patients undergoing MIC and OC for bladder cancer from 2005 to 2010 using the US Nationwide Inpatient Sample. We compared perioperative outcomes using Patient Safety Indicators (PSIs), validated metrics developed by the Agency for Healthcare Research and Quality, and used multivariate regression analyses to generate adjusted odds ratios.
Between 2005 and 2010, 42,919 patients underwent cystectomy. During this period, the prevalence of MIC increased from 0.8% to 10.3% of all cystectomies. Compared with OC, MIC patients were more likely to be male (P = .019) and treated at large teaching hospitals (P <.001). There were no significant differences in age, race, Charlson index, or region between groups. The median lengths of stay were 8 and 7 days for OC and MIC, respectively (P <.001). In multivariate regression analyses, MIC was associated with a 30% decreased likelihood of any PSI (odds ratio, 0.71; P = .038). Although the occurrence of any PSI was associated with increased mortality (P <.001), there were no significant differences in mortality between OC and MIC.
The prevalence of MIC has substantially increased in recent years. Patients undergoing MIC had superior perioperative patient safety outcomes as measured by PSIs. Further study is needed to explain these patterns and to promote the continued safe diffusion of this technology.
在全国范围内的队列中比较微创膀胱切除术（MIC）与开放性膀胱切除术（OC）的围手术期患者安全结局。基于经过验证的指标，MIC 的比较结果数据稀缺，而 MIC 是膀胱癌的一种新兴治疗方法。
我们使用美国全国住院患者样本，从 2005 年至 2010 年期间确定接受 MIC 和 OC 治疗膀胱癌的患者。我们使用患者安全指标（PSIs）比较围手术期结局，这些指标是由医疗保健研究和质量局开发的经过验证的指标，并使用多元回归分析生成调整后的优势比。
在 2005 年至 2010 年期间，有 42919 名患者接受了膀胱切除术。在此期间，MIC 的患病率从所有膀胱切除术的 0.8%增加到 10.3%。与 OC 相比，MIC 患者更可能是男性（P=0.019），并且在大型教学医院接受治疗（P<.001）。两组之间在年龄、种族、Charlson 指数或地区方面没有显着差异。OC 和 MIC 的中位住院时间分别为 8 天和 7 天（P<.001）。在多元回归分析中，MIC 与任何 PSI 的发生可能性降低 30%相关（优势比，0.71；P=0.038）。尽管任何 PSI 的发生与死亡率增加相关（P<.001），但 OC 和 MIC 之间的死亡率没有显着差异。
近年来，MIC 的患病率大幅增加。MIC 患者的围手术期患者安全结局优于 PSIs 所衡量的结果。需要进一步研究来解释这些模式，并促进该技术的持续安全推广。
