Schootman M, Hendren S, Loux T, Ratnapradipa K, Eberth J M, Davidson N O
Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA.
Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO, USA.
J Gastrointest Surg. 2017 Aug;21(8):1296-1303. doi: 10.1007/s11605-017-3460-8. Epub 2017 May 31.
We compared patient outcomes of robot-assisted surgery (RAS) and laparoscopic colectomy without robotic assistance for colon cancer or nonmalignant polyps, comparing all patients, obese versus nonobese patients, and male versus female patients.
We used the 2013-2015 American College of Surgeons National Surgical Quality Improvement Program data to examine a composite outcome score comprised of mortality, readmission, reoperation, wound infection, bleeding transfusion, and prolonged postoperative ileus. We used propensity scores to assess potential heterogeneous treatment effects of RAS by patient obesity and sex.
In all, 17.1% of the 10,844 of patients received RAS. Males were slightly more likely to receive RAS. Obese patients were equally likely to receive RAS as nonobese patients. In comparison to nonRAS, RAS was associated with a 3.1% higher adverse composite outcome score. Mortality, reoperations, wound infections, sepsis, pulmonary embolisms, deep vein thrombosis, myocardial infarction, blood transfusions, and average length of hospitalization were similar in both groups. Conversion to open surgery was 10.1% lower in RAS versus nonRAS patients, but RAS patients were in the operating room an average of 52.4 min longer. We found no statistically significant differences (p > 0.05) by obesity status and gender.
Worse patient outcomes and no differential improvement by sex or obesity suggest more cautious adoption of RAS.
我们比较了机器人辅助手术（RAS）与非机器人辅助的腹腔镜结肠切除术治疗结肠癌或非恶性息肉的患者结局，比较了所有患者、肥胖与非肥胖患者以及男性与女性患者。
我们使用2013 - 2015年美国外科医师学会国家外科质量改进计划数据，来检查一个由死亡率、再入院、再次手术、伤口感染、输血以及术后肠梗阻延长组成的综合结局评分。我们使用倾向评分来评估按患者肥胖程度和性别划分的RAS潜在异质性治疗效果。
总共10844例患者中有17.1%接受了RAS。男性接受RAS的可能性略高。肥胖患者接受RAS的可能性与非肥胖患者相同。与非RAS相比，RAS的不良综合结局评分高3.1%。两组的死亡率、再次手术、伤口感染、败血症、肺栓塞、深静脉血栓形成、心肌梗死、输血以及平均住院时间相似。RAS患者转为开放手术的比例比非RAS患者低10.1%，但RAS患者在手术室的平均时间长52.4分钟。我们未发现肥胖状态和性别方面有统计学显著差异（p>0.05）。
患者结局较差且在性别或肥胖方面无差异改善表明应更谨慎地采用RAS。
