Frenkel Catherine H, Yang Jie, Zhang Mengru, Altieri Maria S, Telem Dana A, Samara Ghassan J
1 Department of General Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA.
2 Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, New York, USA.
Otolaryngol Head Neck Surg. 2017 Nov;157(5):791-797. doi: 10.1177/0194599817706499. Epub 2017 May 9.
Objective Outcomes of concurrent versus staged neck dissection with transoral robotic surgery have not been studied. This study compares outcomes of concurrent versus staged transoral robotic surgery and neck dissection. Design Retrospective administrative database analysis. Setting Article 28 licensed inpatient and outpatient care facilities in New York State. Subjects/Methods Adults undergoing transoral robotic surgery with staged or concurrent neck dissection from 2008 to 2014 were identified in the New York Statewide Planning and Research Collaborative System database. We compared complications, readmissions, subsequent procedures, and length of stay for concurrent versus staged procedures with multivariable logistic regression and multiple linear regression models. Results Of the 425 patients undergoing transoral robotic surgery and neck dissection, 333 had concurrent procedures, and 92 had staged. Risk-adjusted length of stay for concurrent procedures was 42.3% less than that of staged procedures ( P < .0001). Neck dissection timing was not associated with postoperative complications ( P = .41), readmissions ( P = .67), or additional procedures, including reconstruction, tracheostomy, or gastrostomy ( P = .17, .84, .82, respectively). Bleeding (7.8%) was the most common complication, and the majority (78.8%) required reoperation. Bleeding or surgical error was not associated with either concurrent or staged surgery (concurrent vs staged: adjusted odds ratio, 0.68; 95% CI, 0.35-1.37; P = .26). Conclusions Concurrent and staged procedures are equivalent with respect to adverse events, but length of stay is shorter for concurrent procedures. Cost and clinical benefits associated with length of stay are unknown, and it is reasonable to allow operator preference and patient factors to determine surgical logistics.
目的 经口机器人手术同期与分期行颈部清扫术的结果尚未得到研究。本研究比较经口机器人手术同期与分期行颈部清扫术的结果。设计 回顾性管理数据库分析。地点 纽约州第28条许可的住院和门诊护理机构。对象/方法 在纽约州全州规划与研究协作系统数据库中识别出2008年至2014年接受经口机器人手术同期或分期行颈部清扫术的成年人。我们使用多变量逻辑回归和多元线性回归模型比较同期与分期手术的并发症、再入院情况、后续手术及住院时间。结果 在425例行经口机器人手术和颈部清扫术的患者中，333例为同期手术，92例为分期手术。同期手术经风险调整后的住院时间比分期手术短42.3%（P < .0001）。颈部清扫术的时机与术后并发症（P = .41）、再入院情况（P = .67）或包括重建、气管切开术或胃造口术在内的额外手术无关（分别为P = .17、.84、.82）。出血（7.8%）是最常见的并发症，大多数（78.8%）需要再次手术。出血或手术失误与同期或分期手术均无关（同期与分期：调整后的优势比为0.68；95%CI为0.35 - 1.37；P = .26）。结论 同期与分期手术在不良事件方面相当，但同期手术的住院时间更短。与住院时间相关的成本和临床益处尚不清楚，允许术者根据个人偏好和患者因素来确定手术安排是合理的。
