Department of Surgery, University of Michigan, Ann Arbor.
Center for Healthcare Outcomes and Policy, University of Michigan School of Medicine, Ann Arbor.
JAMA Netw Open. 2020 Jan 3;3(1):e1918911. doi: 10.1001/jamanetworkopen.2019.18911.
Increasing use of robotic surgery for common surgical procedures with limited evidence and unclear clinical benefit is raising concern. Analyses of population-based trends in practice and how hospitals' acquisition of robotic surgical technologies is associated with their use are limited.
To characterize trends in the use of robotic surgery for common surgical procedures.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used clinical registry data from Michigan from January 1, 2012, through June 30, 2018. Trends were characterized in the use of robotic surgery for common procedures for which traditional laparoscopic minimally invasive surgery was already considered a safe and effective approach for most surgeons when clinically feasible. A multigroup interrupted time series analysis was performed to determine how procedural approaches (open, laparoscopic, and robotic) change after hospitals launch a robotic surgery program. Data were analyzed from March 1 through April 19, 2019.
Initiation of robotic surgery.
Procedure approach (ie, robotic, open, or laparoscopic).
The study cohort included 169 404 patients (mean [SD] age, 55.4 [16.9] years; 90 595 women [53.5%]) at 73 hospitals. The use of robotic surgery increased from 1.8% in 2012 to 15.1% in 2018 (8.4-fold increase; slope, 2.1% per year; 95% CI, 1.9%-2.3%). For certain procedures, the magnitude of the increase was greater; for example, for inguinal hernia repair, the use of robotic surgery increased from 0.7% to 28.8% (41.1-fold change; slope, 5.4% per year; 95% CI, 5.1%-5.7%). The use of robotic surgery increased 8.8% in the first 4 years after hospitals began performing robotic surgery (2.8% per year; 95% CI, 2.7%-2.9%). This trend was associated with a decrease in laparoscopic surgery from 53.2% to 51.3% (difference, -1.9%; 95% CI, -2.2% to -1.6%). Before adopting robotic surgery, hospitals' use of laparoscopic surgery increased 1.3% per year. After adopting robotic surgery, the use of laparoscopic surgery declined 0.3% (difference in trends, -1.6%; 95% CI, -1.7% to -1.5%).
These results suggest that robotic surgery has continued to diffuse across a broad range of common surgical procedures. Hospitals that launched robotic surgery programs had a broad and immediate increase in the use of robotic surgery, which was associated with a decrease in traditional laparoscopic minimally invasive surgery.
越来越多的医生在有限的证据和不清楚的临床获益的情况下，将机器人手术用于常见的手术，这引发了人们的关注。对基于人群的实践趋势的分析，以及医院获得机器人手术技术与使用之间的关系，目前还很有限。
描述常见手术中机器人手术使用的趋势。
设计、地点和参与者：本队列研究使用了密歇根州从 2012 年 1 月 1 日至 2018 年 6 月 30 日的临床登记数据。在已经认为传统腹腔镜微创手术对大多数医生来说在临床上可行的情况下，对机器人手术用于常见手术的使用趋势进行了特征描述。采用多组中断时间序列分析来确定医院推出机器人手术项目后，手术方法（开放、腹腔镜和机器人）如何变化。数据于 2019 年 3 月 1 日至 4 月 19 日进行分析。
机器人手术的启动。
手术方法（即机器人、开放或腹腔镜）。
研究队列包括来自 73 家医院的 169404 名患者（平均[标准差]年龄为 55.4[16.9]岁；90595 名女性[53.5%]）。机器人手术的使用率从 2012 年的 1.8%上升到 2018 年的 15.1%（增加了 8.4 倍；斜率为每年 2.1%；95%CI，2.0%-2.2%）。对于某些手术，增加的幅度更大；例如，对于腹股沟疝修补术，机器人手术的使用率从 0.7%上升到 28.8%（增加了 41.1 倍；斜率为每年 5.4%；95%CI，5.1%-5.7%）。在医院开始进行机器人手术的前 4 年中，机器人手术的使用率增加了 8.8%（每年增加 2.8%；95%CI，2.7%-2.9%）。这一趋势与腹腔镜手术使用率从 53.2%下降到 51.3%有关（差值，-1.9%；95%CI，-2.2%至-1.6%）。在采用机器人手术之前，医院每年增加 1.3%的腹腔镜手术。采用机器人手术后，腹腔镜手术的使用率下降了 0.3%（趋势差异，-1.6%；95%CI，-1.7%至-1.5%）。
这些结果表明，机器人手术已经在广泛的常见手术中继续普及。开展机器人手术项目的医院机器人手术的使用有广泛而迅速的增加，这与传统腹腔镜微创手术的减少有关。
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