非机器人辅助与机器人辅助心脏手术的关键结果。

Critical Outcomes in Nonrobotic vs Robotic-Assisted Cardiac Surgery.

机构信息

Department of General Surgery, York Hospital, York, Pennsylvania.

Department of Research, York Hospital, York, Pennsylvania.

出版信息

JAMA Surg. 2015 Aug;150(8):771-7. doi: 10.1001/jamasurg.2015.1098.

DOI:10.1001/jamasurg.2015.1098

PMID:26083734

Abstract

IMPORTANCE

As robotic-assisted cardiac surgical procedures increase nationwide, surgeons need to be educated on the safety of the new modality compared with that of open technique.

OBJECTIVE

To compare complications, length of stay (LOS), actual cost, and mortality between nonrobotic and robotic-assisted cardiac surgical procedures.

DESIGN, SETTING, AND PARTICIPANTS: Weighted data on cardiac patients who had undergone operations involving the valves or septa and vessels, as well as other heart and pericardium procedures, from January 1, 2008, to December 31, 2011, were obtained from the Nationwide Inpatient Sample via the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. Propensity score matching was used to match each robotic-assisted case to 2 nonrobotic cases on 14 characteristics.

MAIN OUTCOMES AND MEASURES

Complications, median LOS, actual cost, and mortality.

RESULTS

Exploratory analysis found a total of 1,374,653 cardiac cases (1,369,454 [99.6%] nonrobotic and 5199 [0.4%] robotic-assisted cases). After propensity score matching, there were 10,331 (66.5%) nonrobotic cases and 5199 (33.5%) robotic-assisted cases. Cardiac operations included 1630 (10.5%) involving the valves or septa, 6616 (42.6%) involving the vessels, and 7284 (46.9%) other heart and pericardium procedures. Robotic-assisted compared with nonrobotic surgery had a higher median cost ($39,030 vs $36,340; P < .001) but lower LOS (5 vs 6 days; P < .001) and lower mortality (1.0% vs 1.9%; P < .001). Robotic-assisted surgery had significantly fewer complications for all operation types (30.3% vs 27.2%; P < .001).

CONCLUSIONS AND RELEVANCE

Overall, robotic-assisted surgery has significantly reduced median LOS, complications, and mortality compared with nonrobotic surgery. Results of this study support the contention that robotic-assisted surgery is as safe as nonrobotic surgery and offers the surgeon an additional technique for performing cardiac surgery.

摘要

重要性

随着全国范围内开展的机器人辅助心脏手术的增加，外科医生需要了解新方法与开放技术相比的安全性。

目的

比较非机器人辅助和机器人辅助心脏手术的并发症、住院时间（LOS）、实际成本和死亡率。

设计、地点和参与者：从 2008 年 1 月 1 日至 2011 年 12 月 31 日，通过医疗保健成本和利用项目机构的医疗保健研究和质量的全国住院患者样本中获得了涉及瓣膜或间隔以及其他心脏和心包手术的心脏患者的加权数据。使用倾向评分匹配将每个机器人辅助病例与 14 个特征上的 2 个非机器人辅助病例进行匹配。

主要结果和测量

并发症、中位 LOS、实际成本和死亡率。

结果

探索性分析发现，共有 1374653 例心脏病例（1369454 例[99.6%]非机器人辅助和 5199 例[0.4%]机器人辅助）。在进行倾向评分匹配后，有 10331 例（66.5%）非机器人辅助病例和 5199 例（33.5%）机器人辅助病例。心脏手术包括 1630 例（10.5%）涉及瓣膜或间隔，6616 例（42.6%）涉及血管，7284 例（46.9%）其他心脏和心包手术。与非机器人手术相比，机器人辅助手术的中位费用更高（$39030 与 $36340；P<.001），但 LOS 更短（5 天与 6 天；P<.001），死亡率更低（1.0%与 1.9%；P<.001）。机器人辅助手术在所有手术类型中并发症明显较少（30.3%与 27.2%；P<.001）。