Ackerman Stacey J, Daniel Shoshana, Baik Rebecca, Liu Emelline, Mehendale Shilpa, Tackett Scott, Hellan Minia
a Covance Market Access Services , San Diego , CA , USA.
b Covance Market Access Services , Gaithersburg , MD , USA.
J Med Econ. 2018 Mar;21(3):254-261. doi: 10.1080/13696998.2017.1396994. Epub 2017 Nov 14.
To compare (1) complication and (2) conversion rates to open surgery (OS) from laparoscopic surgery (LS) and robotic-assisted surgery (RA) for rectal cancer patients who underwent rectal resection. (3) To identify patient, physician, and hospital predictors of conversion.
A US-based database study was conducted utilizing the 2012-2014 Premier Healthcare Data, including rectal cancer patients ≥18 with rectal resection. ICD-9-CM diagnosis and procedural codes were utilized to identify surgical approaches, conversions to OS, and surgical complications. Propensity score matching on patient, surgeon, and hospital level characteristics was used to create comparable groups of RA\LS patients (n = 533 per group). Predictors of conversion from LS and RA to OS were identified with stepwise logistic regression in the unmatched sample.
Post-match results suggested comparable perioperative complication rates (RA 29% vs LS 29%; p = .7784); whereas conversion rates to OS were 12% for RA vs 29% for LS (p < .0001). Colorectal surgeons (RA 9% vs LS 23%), general surgeons (RA 13% vs LS 35%), and smaller bed-size hospitals (RA 14% vs LS 33%) have reduced conversion rates for RA vs LS (p < .0001). Statistically significant predictors of conversion included LS, non-colorectal surgeon, and smaller bed-size hospitals.
Retrospective observational study limitations apply. Analysis of the hospital administrative database was subject to the data captured in the database and the accuracy of coding. Propensity score matching limitations apply. RA and LS groups were balanced with respect to measured patient, surgeon, and hospital characteristics.
Compared to LS, RA offers a higher probability of completing a successful minimally invasive surgery for rectal cancer patients undergoing rectal resection without exacerbating complications. Male, obese, or moderately-to-severely ill patients had higher conversion rates. While colorectal surgeons had lower conversion rates from RA than LS, the reduction was magnified for general surgeons and smaller bed-size hospitals.
比较（1）接受直肠切除术的直肠癌患者腹腔镜手术（LS）和机器人辅助手术（RA）的并发症发生率及（2）转为开腹手术（OS）的转化率。（3）确定患者、医生和医院层面转为开腹手术的预测因素。
利用2012 - 2014年美国Premier医疗保健数据库进行一项基于美国的数据库研究，纳入年龄≥18岁且接受直肠切除术的直肠癌患者。使用国际疾病分类第九版临床修订本（ICD - 9 - CM）诊断和手术操作编码来确定手术方式、转为开腹手术的情况以及手术并发症。在患者、外科医生和医院层面特征上进行倾向评分匹配，以创建可比的RA/LS患者组（每组n = 533）。在未匹配样本中，采用逐步逻辑回归确定从LS和RA转为OS的预测因素。
匹配后的结果显示围手术期并发症发生率相当（RA为29%，LS为29%；p = 0.7784）；而RA转为OS的比率为12%，LS为29%（p < 0.0001）。结直肠外科医生（RA为9%，LS为23%）、普通外科医生（RA为13%，LS为35%）以及床位规模较小的医院（RA为14%，LS为33%），RA相对于LS的转化率降低（p < 0.0001）。转为开腹手术的具有统计学意义的预测因素包括LS、非结直肠外科医生以及床位规模较小的医院。
存在回顾性观察性研究的局限性。对医院行政数据库的分析受数据库中所记录的数据及其编码准确性的影响。存在倾向评分匹配的局限性。RA和LS组在已测量的患者、外科医生和医院特征方面达到了平衡。
与LS相比，RA为接受直肠切除术的直肠癌患者成功完成微创手术提供了更高的概率，且不会增加并发症。男性、肥胖或中重度疾病患者的转化率更高。虽然结直肠外科医生进行RA手术时的转化率低于LS，但普通外科医生和床位规模较小的医院这种降低更为明显。
