Department of Surgery, City of Hope, Duarte, CA.
Department of Surgery, University of Michigan, Ann Arbor, MI.
Surgery. 2019 Nov;166(5):867-872. doi: 10.1016/j.surg.2019.05.008. Epub 2019 Jun 14.
We hypothesized that general surgeons are more likely to use a robotic surgical platform at hospitals where more urologic and gynecologic robotic operations are performed, suggesting that hospital-related factors are important for choice of usage of minimally invasive platforms.
We queried the National Inpatient Sample from 2010 to 2014 for patients who underwent stomach, gallbladder, pancreas, spleen, colon and rectum, or hernia (general surgery), prostate or kidney (urologic surgery), and ovarian or uterine surgery (gynecologic surgery). Hospitals were grouped into quartiles according to percent volume of robotic urologic or gynecologic operations. Multivariable logistic regression modeling determined independent variables associated with robotics.
Survey-weighted results represented 482,227 open, 240,360 laparoscopic, and 42,177 robotic general surgical operations at 3,933 hospitals. Robotics use increased with each year studied and was more likely to be performed on younger men with private insurance. The odds of a general surgery patient receiving a robotic operation increased with urologic and gynecologic use at the hospital. Patients at top quartile hospitals for robotic urologic surgery had 1.34 times greater odds of receiving robotic general surgery operations (confidence interval 1.15-1.57, P < .001) and 1.53 times greater odds (confidence interval 1.32-1.79, P < .001) at top quartile robotic gynecologic hospitals. These findings were independent of study year, surgical site, insurance type, and hospital type and persisted when only comparing laparoscopic to robotic procedures.
Use of robotics in general surgery is independently associated with use in urologic and gynecologic surgery at a hospital, suggesting that institutional factors are important drivers of use when considering laparoscopy versus robotics in general surgery.
我们假设，在进行更多泌尿科和妇科机器人手术的医院，普通外科医生更有可能使用机器人手术平台，这表明医院相关因素对于微创平台的使用选择很重要。
我们从 2010 年至 2014 年的国家住院患者样本中查询了接受胃、胆囊、胰腺、脾脏、结肠和直肠或疝（普通外科手术）、前列腺或肾脏（泌尿科手术）和卵巢或子宫手术（妇科手术）的患者。医院根据机器人泌尿科或妇科手术的百分比体积分为 quartiles（四分位数）。多变量逻辑回归模型确定了与机器人相关的独立变量。
调查加权结果代表了 3933 家医院的 482227 例开放性、240360 例腹腔镜和 42177 例机器人普通外科手术。机器人的使用随着研究年份的增加而增加，并且更有可能在接受私人保险的年轻男性中进行。普通外科患者接受机器人手术的可能性随着医院泌尿科和妇科手术的增加而增加。在泌尿科机器人手术中排名前四分之一的医院的患者接受机器人普通外科手术的可能性增加了 1.34 倍（置信区间为 1.15-1.57，P<0.001），在妇科机器人手术中排名前四分之一的医院的患者接受机器人普通外科手术的可能性增加了 1.53 倍（置信区间为 1.32-1.79，P<0.001）。这些发现独立于研究年份、手术部位、保险类型和医院类型，并且当仅比较腹腔镜与机器人手术时仍然存在。
普通外科手术中机器人的使用与医院泌尿科和妇科手术的使用独立相关，这表明在考虑普通外科手术中腹腔镜与机器人手术时，机构因素是使用的重要驱动因素。
