开放性与微创性部分肾切除术的围手术期发病率：国家外科质量改进计划的当代分析
Perioperative Morbidity of Open Versus Minimally Invasive Partial Nephrectomy: A Contemporary Analysis of the National Surgical Quality Improvement Program.
作者信息
Pereira Jorge, Renzulli Joseph, Pareek Gyan, Moreira Daniel, Guo Ruiting, Zhang Zheng, Amin Ali, Mega Anthony, Golijanin Dragan, Gershman Boris
机构信息
1 Minimally Invasive Urology Institute , The Miriam Hospital, Providence, Rhode Island.
2 Warren Alpert Medical School of Brown University , Providence, Rhode Island.
出版信息
J Endourol. 2018 Feb;32(2):116-123. doi: 10.1089/end.2017.0609. Epub 2017 Dec 21.
INTRODUCTION AND OBJECTIVES
In recent years, there has been a shift to minimally invasive partial nephrectomy (MIPN) with the dissemination of robot-assisted technology. However, contemporary data on the comparative morbidity of open partial nephrectomy (OPN) and MIPN are lacking. We, therefore, evaluated the perioperative morbidity of OPN and MIPN using a contemporary national cohort.
METHODS
We identified 13,658 patients aged 18 to 89 who underwent PN from 2010 to 2015 in the National Surgical Quality Improvement Program (NSQIP) database, of whom 9018 (66.0%) underwent MIPN. The associations of MIPN with 30-day morbidity were evaluated using logistic regression, adjusted for patient features.
RESULTS
Median age at surgery was 60 (interquartile range [IQR] 51, 68) years. Overall, 30-day complications occurred in 6.7% of patients. Compared with OPN, MIPN was associated with lower rates of 30-day complications (4.9% vs 10.1%, p < 0.0001), perioperative blood transfusion (3.8% vs 12.5%, p < 0.0001), prolonged hospitalization (5.6% vs 23.4%, p < 0.0001), readmission (4.4% vs 7.8%, p < 0.0001), reoperation (1.8% vs 3.2%, p < 0.0001), and 30-day mortality (0.3% vs 0.6%, p = 0.001). On multivariable analysis, MIPN was independently associated with a reduced risk of 30-day complications (odds ratio [OR] 0.46, p < 0.0001), perioperative blood transfusion (OR 0.27, p < 0.0001), prolonged hospitalization (OR 0.19, p < 0.0001), readmission (OR 0.59, p < 0.0001), and reoperation (OR 0.57, p < 0.0001). Postoperative complications occurred predominantly early after surgery, whereas hospital readmissions and reoperation occurred at a consistent rate.
CONCLUSIONS
In this contemporary national cohort, MIPN was independently associated with reduced rates of 30-day complications, perioperative blood transfusion, prolonged hospitalization, hospital readmission, and reoperation, compared with OPN.
引言与目的
近年来，随着机器人辅助技术的普及，部分肾切除术已转向微创部分肾切除术（MIPN）。然而，目前缺乏关于开放性部分肾切除术（OPN）和MIPN相对发病率的当代数据。因此，我们使用当代全国队列评估了OPN和MIPN的围手术期发病率。
方法
我们在国家外科质量改进计划（NSQIP）数据库中确定了13658例年龄在18至89岁之间、在2010年至2015年期间接受部分肾切除术的患者，其中9018例（66.0%）接受了MIPN。使用逻辑回归评估MIPN与30天发病率的关联，并根据患者特征进行调整。
结果
手术时的中位年龄为60岁（四分位间距[IQR]51，68）。总体而言，6.7%的患者出现了30天并发症。与OPN相比，MIPN的30天并发症发生率较低（4.9%对10.1%，p<0.0001）、围手术期输血率较低（3.8%对12.5%，p<0.0001）、住院时间延长率较低（5.6%对23.4%，p<0.0001）、再入院率较低（4.4%对7.8%，p<0.0001）、再次手术率较低（1.8%对3.2%，p<0.0001）以及30天死亡率较低（0.3%对0.6%，p=0.001）。在多变量分析中，MIPN与30天并发症风险降低（优势比[OR]0.46，p<0.0001）、围手术期输血风险降低（OR 0.27，p<0.0001）、住院时间延长风险降低（OR 0.
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