Altieri Maria S, Yang Jie, Xu Jianjin, Talamini Mark, Pryor Aurora, Telem Dana A
Am Surg. 2018 Jun 1;84(6):902-908.
The purpose of our study is to assess outcomes following robotic ventral hernia (RVH) repair. The New York Statewide Planning and Research Cooperative System administrative database was used to identify all patients undergoing laparoscopic ventral hernia (LVH) and RVH between 2010 and 2013. Outcome measures including complications, hospital length of stay (HLOS), 30-day readmissions, and 30-day emergency department (ED) visits were compared. Propensity score (PS) analysis was used to estimate the adjusted marginal differences between patients who underwent robotic-assisted and laparoscopic procedures. There were 20,896 LVH and 679 (3.2%) RVH repairs. Initial univariate analysis demonstrated that patients undergoing RVH had worse outcomes in terms of complications (20.18% vs 10.56%, P < 0.0001), longer HLOS (4.32 vs 2.19 days, P = 0.0023), higher rates in 30-day readmissions (9.28% vs 5.06%, P < 0.0001), and 30-day ED visits (14.43% vs 10.46%, P < 0.0001). Following PS analysis, which accounts for all patient associated variables, there was no difference found in 30-day readmission or 30-day ED visits between RVH and LVH (P = 0.2760 and 0.2043, respectively). Patients undergoing RVH had a significantly shorter HLOS (P < 0.0001) and lower rate of complications (P = 0.0134). Following PS analysis, this study demonstrates that RVH may be associated with shorter HLOS and lower complication rate. Further studies are necessary to compare laparoscopic and robotic approaches for ventral hernia.
我们研究的目的是评估机器人辅助腹疝（RVH）修补术后的结果。利用纽约州全州规划与研究合作系统管理数据库，识别出2010年至2013年间所有接受腹腔镜腹疝（LVH）和RVH修补术的患者。比较了包括并发症、住院时间（HLOS）、30天再入院率和30天急诊科（ED）就诊次数等结果指标。采用倾向评分（PS）分析来估计接受机器人辅助手术和腹腔镜手术患者之间的调整后边际差异。共有20,896例LVH修补术和679例（3.2%）RVH修补术。初始单因素分析表明，接受RVH修补术的患者在并发症方面结果更差（20.18%对10.56%，P<0.0001），HLOS更长（4.32天对2.19天，P = 0.0023），30天再入院率更高（9.28%对5.06%，P<0.0001），以及30天ED就诊率更高（14.43%对10.46%，P<0.0001）。在进行考虑所有患者相关变量的PS分析后，RVH和LVH之间在30天再入院率或30天ED就诊次数方面未发现差异（分别为P = 0.2760和0.2043）。接受RVH修补术的患者HLOS显著更短（P<0.0001），并发症发生率更低（P = 0.0134）。经过PS分析，本研究表明RVH可能与更短的HLOS和更低的并发症发生率相关。有必要进一步研究比较腹腔镜和机器人辅助治疗腹疝的方法。
