Flack Chandra K, Monn M Francesca, Patel Neil B, Gardner Thomas A, Powell Charles R
Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana.
J Endourol. 2015 Jul;29(7):777-83. doi: 10.1089/end.2014.0710. Epub 2015 Mar 10.
Robot-assisted sacral colpopexy (RASC) utilization trends and influencing factors were examined. RASCs were compared with nonrobotic vaginal suspension procedures (non-RASC) used to treat patients with vaginal prolapse. Hospital costs associated with each approach were also examined. The presence of certain factors may predict increased use of RASC.
The National (Nationwide) Inpatient Sample database was queried from 2009 to 2011 to identify patients undergoing RASC and non-RASC. Multivariable logistic regression was used to evaluate variables associated with RASC utilization, adjusting for age, comorbidities, concurrent procedures, hospital region, primary payer, and year. Multiple linear regression was used to evaluate variables associated with hospital costs when adjusting for operative approach, concurrent procedures, comorbidities, presence of complications, hospital region, and year.
Of the 125,869 patients who underwent vaginal vault suspension of any type, 14,601 (12%) were RASC. Total in-hospital complication rates were similar between RASC and non-RASC (8% RASC, 7% non-RASC, P=0.360). The proportion of patients undergoing RASC increased throughout the study period (odds ratio [OR] 1.58, P<0.001), with this increase being most pronounced in the South (OR 2.22, P<0.001). Fifty-four percent of RASC patients vs 48% of non-RASC patients underwent concurrent hysterectomy (P=0.007). Patients with private insurance (OR 1.73, P=0.001) or Medicare (OR 1.43, P=0.033) as their primary payer were at significantly increased odds of RASC compared with Medicaid patients, and private insurance was associated with increased reimbursement. On multiple linear regression, RASC was independently associated with a $4825 increase in hospital costs (95% confidence interval $4161-$5490, P<0.001). There were independent regional differences in cost associated with vaginal suspension, with the West being the most expensive (P<0.001).
While RASC utilization increased over the study period as a treatment option for vaginal prolapse, the majority of vaginal suspension procedures were still performed via non-RASC methods. RASC was associated with equivalent complications yet significantly higher costs.
研究机器人辅助骶骨阴道固定术（RASC）的使用趋势及影响因素。将RASC与用于治疗阴道脱垂患者的非机器人阴道悬吊术（非RASC）进行比较。还研究了每种手术方式的住院费用。某些因素的存在可能预示着RASC使用的增加。
查询2009年至2011年的国家（全国）住院患者样本数据库，以识别接受RASC和非RASC手术的患者。采用多变量逻辑回归评估与RASC使用相关的变量，并对年龄、合并症、同期手术、医院所在地区、主要支付方和年份进行调整。采用多元线性回归评估在调整手术方式、同期手术、合并症、并发症的存在、医院所在地区和年份后与住院费用相关的变量。
在125869例接受任何类型阴道穹窿悬吊术的患者中，14601例（12%）接受了RASC。RASC和非RASC的院内总并发症发生率相似（RASC为8%，非RASC为7%，P=0.360）。在整个研究期间，接受RASC手术的患者比例有所增加（优势比[OR]为1.58，P<0.001），这种增加在南部最为明显（OR为2.22，P<0.001）。54%的RASC患者与48%的非RASC患者同期进行了子宫切除术（P=0.007）。以私人保险（OR为1.73，P=0.001）或医疗保险（OR为1.43，P=0.033）作为主要支付方的患者与医疗补助患者相比，接受RASC的几率显著增加，且私人保险与更高的报销相关。在多元线性回归中，RASC与住院费用增加4825美元独立相关（95%置信区间为4161美元至5490美元，P<0.001）。阴道悬吊术的费用存在独立的地区差异，西部地区费用最高（P<0.001）。
虽然在研究期间RASC作为阴道脱垂的一种治疗选择使用有所增加，但大多数阴道悬吊术仍通过非RASC方法进行。RASC相关并发症相当，但费用显著更高。
