School of Medicine, Oregon Health and Science University, Portland, OR, USA.
School of Public Health, Oregon Health and Science University, Portland, OR, USA.
J Robot Surg. 2019 Feb;13(1):129-140. doi: 10.1007/s11701-018-0832-3. Epub 2018 Jun 8.
The objectives of this study are to evaluate if robotic cystectomy demonstrates reduced complications, readmissions, and cost-to-patient compared to open approach 30-day post-operatively, and to identify predictors of complication, readmission, and cost-to-patient. This retrospective cohort study analyzed 249 patients who underwent open (n = 149) or robotic (n = 100) cystectomy from 2009 to 2015 at our institution. Outcomes included 30-day post-operative complication, readmission, and cost-to-patient charges. We used modified Clavien-Dindo/MSKCC classifications. Multivariable logistic and linear regression models were used to evaluate associations to outcomes and to build predictive models. Patient, clinical, and surgical characteristics differed by open and robotic groups, respectively, only for estimated blood loss (median: 600 versus 150 cc, p < 0.01), operative time (mean: 6.19 versus 6.85 h, p < 0.01), and length of stay (median: 7 versus 5 days, p < 0.01). Complication: frequency of patients with at least one 30-day complication was 85% compared to 66% (p < 0.01). Minor gastrointestinal and bleeding complications were increased in the open group (50% versus 41%, p = 0.01; 52% versus 11%, p < 0.01, respectively). Fifty percent of patients required blood transfusion in open compared to 11% (p < 0.01). Patients in the open group experienced more major complications (19% versus 10%, p = 0.04). Robotic approach was a predictor for fewer complications (OR 0.44, 95% CI 0.20-0.99, p = 0.049). Readmission: no significant difference in number of patients readmitted was found. Cost-to-patient: Robotic approach predicted an 18% reduction in total cost-to-patient compared to open approach (p < 0.01). Robotic cystectomy demonstrated reduced total cost-to-patient when taking into account all 30-day post-operative services with fewer complications compared to open cystectomy.
本研究的目的是评估与开放手术相比，机器人膀胱切除术在术后 30 天是否具有更低的并发症、再入院率和每位患者的成本，并确定并发症、再入院和每位患者成本的预测因素。本回顾性队列研究分析了 2009 年至 2015 年在我院接受开放（n=149）或机器人（n=100）膀胱切除术的 249 名患者。结果包括术后 30 天的并发症、再入院和每位患者的费用。我们使用改良的 Clavien-Dindo/MSKCC 分类。多变量逻辑回归和线性回归模型用于评估与结果的关联，并建立预测模型。患者、临床和手术特征分别因开放组和机器人组而异，仅在估计失血量（中位数：600 与 150cc，p<0.01）、手术时间（均值：6.19 与 6.85h，p<0.01）和住院时间（中位数：7 与 5 天，p<0.01）方面存在差异。并发症：至少有 1 例 30 天并发症的患者频率为 85%，而 66%（p<0.01）。开放组的轻微胃肠道和出血并发症增加（50%与 41%，p=0.01；52%与 11%，p<0.01）。开放组有 50%的患者需要输血，而 11%（p<0.01）。开放组患者出现更多严重并发症（19%与 10%，p=0.04）。机器人方法是并发症减少的预测因素（OR 0.44，95%CI 0.20-0.99，p=0.049）。再入院：再入院患者的数量无显著差异。每位患者的成本：与开放手术相比，机器人手术预测每位患者的总成本降低 18%（p<0.01）。与开放膀胱切除术相比，机器人膀胱切除术在考虑所有术后 30 天服务的情况下，具有更低的总成本，并且并发症更少。
