Coakley Kathleen M, Sims Stephanie M, Prasad Tanushree, Lincourt Amy E, Augenstein Vedra A, Sing Ronald F, Heniford B Todd, Colavita Paul D
Carolinas Medical Center, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Charlotte, NC, USA.
Carolinas Medical Center, Division of Acute Care Surgery, Department of Surgery, Charlotte, NC, USA.
Am J Surg. 2017 Dec;214(6):1158-1163. doi: 10.1016/j.amjsurg.2017.08.022. Epub 2017 Sep 20.
The purpose of this study was to examine outcomes of robotic ventral hernia repair(RVHR) versus laparoscopic ventral hernia repair(LVHR).
The Nationwide Inpatient Sample was queried from October 2008 to December 2013 for ventral hernia repairs. Demographics, morbidity, mortality, and charges were compared between RVHR and LVHR.
From 2008-2013, 149,622 ventral hernia surgeries were identified; 117,028 open, 32,243 laparoscopic, and 351 robotic. Open repairs were excluded. RVHR rose annually with 2013 containing 47.9% of all RVHRs. RVHR patients were more likely to be older and have more chronic conditions. There was no difference between length of stay. Pneumonia rates were higher with RVHR; however, after controlling for confounding variables, there was no difference in pneumonia rates. Mortality and other major complications were similar. Total charges were increased for RVHR in univariate and multivariate analysis. RVHR was more common in teaching hospitals and wealthier zip codes.
RVHR demonstrates comparable safety to the laparoscopic technique, with increased charges and increased volume in urban teaching hospitals and patients from areas of higher median income.
本研究的目的是比较机器人辅助腹疝修补术（RVHR）与腹腔镜腹疝修补术（LVHR）的疗效。
查询2008年10月至2013年12月全国住院患者样本中的腹疝修补术病例。比较RVHR和LVHR患者的人口统计学特征、发病率、死亡率及费用。
2008 - 2013年，共识别出149,622例腹疝手术；其中117,028例为开放手术，32,243例为腹腔镜手术，351例为机器人辅助手术。排除开放手术病例。RVHR的病例数逐年上升，2013年占所有RVHR病例的47.9%。RVHR患者年龄更大，慢性病更多。住院时间无差异。RVHR患者的肺炎发生率更高；然而，在控制混杂变量后，肺炎发生率无差异。死亡率和其他主要并发症相似。单因素和多因素分析均显示RVHR的总费用增加。RVHR在教学医院和较高收入地区的邮政编码区域更为常见。
RVHR与腹腔镜技术相比安全性相当，但费用增加，在城市教学医院以及来自中等收入较高地区的患者中病例数增加。
