Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA.
Franchise Health Economics and Market Access, Ethicon, Somerville, NJ, USA.
Surg Endosc. 2020 Feb;34(2):610-621. doi: 10.1007/s00464-019-06805-y. Epub 2019 May 14.
We used a population-based database to: (1) compare clinical and economic outcomes between minimally invasive surgery (MIS) and open surgery (OS) for colectomy; and (2) evaluate contemporary trends in MIS rates.
Retrospective Premier Healthcare Database review of patients undergoing elective inpatient colectomy between January 1, 2010 and September 30, 2017 (first = index admission). Patients were classified into MIS (laparoscopic/robotic) or OS groups, and by left or right colectomy. Propensity score matching (1:1 ratio) of MIS and OS groups was used to address potential confounding from patient/hospital/provider characteristics. Study outcomes, measured during index admission, included major perioperative complications [anastomotic leak (AL), bleeding, infection, and a composite of infection/AL], operating room time (ORT), length of stay (LOS), and total hospital costs.
Among 134,970 study-eligible patients, MIS rates increased from ~ 2% (2010) to 19-23% (2017), driven by a > tenfold increase in robotic surgery. The matched MIS and OS colectomy groups comprised 46,708 (left) and 44,560 (right) total patients. Risks of AL, bleeding, and infection were lower for MIS versus OS (all p < 0.001). In left: AL occurred in 7.9% of MIS versus 9.9% of OS; bleeding 7.8% versus 9.7%; infection 3.3% versus 5.8%; infection/AL 9.8% versus 13.3%. In right: AL 8.9% versus 11.1%; bleeding 9.8% versus 10.8%; infection 3.0% versus 5.1%; infection/AL 10.5% versus 10.4%. Although ORTs were longer with MIS (left: 240.8 vs. 216.2 min; right: 192.8 vs. 178.0 min), LOS was shorter (left: 5.4 vs. 7.1 days; right: 5.5 vs. 7.1 days), and total hospital costs were lower (left: $18,564 vs. $19,960; right: $17,375 vs. $19,417) versus OS (all p < 0.001).
Compared with OS, MIS was associated with significantly lower risk of major perioperative complications (including AL), lower LOS, and lower total hospital costs, despite longer OR times. MIS colectomy rates have increased over time; recent gains appear to be due to uptake of robotic surgery.
我们使用基于人群的数据库：（1）比较微创手术 (MIS) 和开放手术 (OS) 治疗结肠切除术的临床和经济结局；（2）评估 MIS 率的当代趋势。
对 2010 年 1 月 1 日至 2017 年 9 月 30 日期间接受择期住院结肠切除术的 Premier Healthcare Database 进行回顾性研究（首次 = 索引入院）。患者分为 MIS（腹腔镜/机器人）或 OS 组，并按左或右结肠切除术进行分类。MIS 和 OS 组之间使用倾向评分匹配（1:1 比例）来解决患者/医院/提供者特征的潜在混杂因素。在索引入院期间测量的研究结果包括主要围手术期并发症[吻合口漏 (AL)、出血、感染和感染/AL 复合]、手术室时间 (ORT)、住院时间 (LOS) 和总住院费用。
在 134970 名符合研究条件的患者中，MIS 率从 2010 年的~2%增加到 2017 年的 19-23%，这主要得益于机器人手术的增加了十倍以上。匹配的 MIS 和 OS 结肠切除术组包括 46708 名（左侧）和 44560 名（右侧）总患者。与 OS 相比，MIS 的 AL、出血和感染风险较低（均 < 0.001）。在左侧：MIS 发生 AL 的比例为 7.9%，OS 为 9.9%；出血 7.8% vs. 9.7%；感染 3.3% vs. 5.8%；感染/AL 9.8% vs. 13.3%。在右侧：MIS 发生 AL 的比例为 8.9%，OS 为 11.1%；出血 9.8% vs. 10.8%；感染 3.0% vs. 5.1%；感染/AL 10.5% vs. 10.4%。尽管 MIS 的 ORT 时间较长（左侧：240.8 与 216.2 分钟；右侧：192.8 与 178.0 分钟），但 LOS 更短（左侧：5.4 与 7.1 天；右侧：5.5 与 7.1 天），总住院费用更低（左侧：18564 美元与 19960 美元；右侧：17375 美元与 19417 美元）与 OS 相比（均 < 0.001）。
与 OS 相比，MIS 与主要围手术期并发症（包括 AL）的风险显著降低、LOS 降低和总住院费用降低相关，尽管 ORT 时间较长。MIS 结肠切除术的比例一直在增加；最近的增长似乎是由于机器人手术的采用。
