Chan John K, Gardner Austin B, Taylor Katie, Blansit Kevin, Thompson Caroline A, Brooks Rebecca, Yu Xinhua, Kapp Daniel S
Division of Gynecologic Oncology, California Pacific Palo Alto Medical Foundation, San Francisco, CA, USA.
Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA.
Gynecol Oncol. 2015 Jul;138(1):128-32. doi: 10.1016/j.ygyno.2015.04.031. Epub 2015 Apr 28.
To evaluate the hospital and patient factors associated with robotic surgery for endometrial cancer in the United States.
Data was obtained from the Nationwide Inpatient Sample from the year 2010. Chi-squared and multivariate analyses were used for statistical analysis.
Of the 6560 endometrial cancer patients who underwent surgery, the median age was 62 (range: 22 to 99). 1647 (25%) underwent robotic surgery, 820 (13%) laparoscopic, and 4093 (62%) had open surgery. The majority was White (65%). Hospitals with 76 or more hysterectomy cases for endometrial cancer patients per year (4% of hospitals in the study) performed 31% of all hysterectomies and 40% of all robotic hysterectomies (p<0.01). 29% of Whites had robotic surgery compared to 15% of Hispanics, 12% of Blacks, and 11% of Asians (p<0.01). Patients with upper-middle and high incomes underwent robotic surgery more than patients with low or middle incomes (p<0.01). 27% of Medicare patients and 26% of patients with private insurance had robotic surgery compared to only 14% of Medicaid patients and 12% of uninsured patients (p<0.01).
The majority of robotic surgeries for endometrial cancer were performed at a small number of high-volume hospitals in the United States. Socioeconomic status, insurance type, and race were also important predictors for the use of RS. Further studies are warranted to better understand the barriers to receiving minimally invasive surgery.
评估美国与子宫内膜癌机器人手术相关的医院和患者因素。
数据取自2010年的全国住院患者样本。采用卡方检验和多变量分析进行统计分析。
在6560例行手术的子宫内膜癌患者中，中位年龄为62岁（范围：22至99岁）。1647例（25%）接受了机器人手术，820例（13%）接受了腹腔镜手术，4093例（62%）接受了开放手术。大多数患者为白人（65%）。每年为子宫内膜癌患者进行76例或更多子宫切除术的医院（占研究中医院的4%）实施了所有子宫切除术的31%和所有机器人子宫切除术的40%（p<0.01）。29%的白人接受了机器人手术，相比之下，西班牙裔为15%，黑人12%，亚洲人11%（p<0.01）。中高收入患者比低收入或中等收入患者接受机器人手术的比例更高（p<0.01）。27%的医疗保险患者和26%的私人保险患者接受了机器人手术，相比之下，医疗补助患者仅为14%，未参保患者为12%（p<0.01）。
美国大多数子宫内膜癌机器人手术在少数几家高手术量的医院进行。社会经济地位、保险类型和种族也是机器人手术使用的重要预测因素。有必要进行进一步研究，以更好地了解接受微创手术的障碍。
