St. Luke's University Hospital and Health Network (SLUHN), Bethlehem, Pennsylvania.
St. Luke's University Hospital and Health Network (SLUHN), Bethlehem, Pennsylvania.
Surg Obes Relat Dis. 2020 Jul;16(7):916-922. doi: 10.1016/j.soard.2020.01.006. Epub 2020 Mar 23.
Robotic surgery is increasingly being used in bariatric surgery; however, the benefits of robotic surgery in bariatrics remain controversial.
The objective of this study was to compare the outcomes of robotic bariatric surgery with laparoscopic surgery over a 3-year period between 2015 and 2017 using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database.
University Hospital, United States.
Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for the years 2015 to 2017, we included patients who underwent primary robotic or laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass procedures. Patients were divided into either robotic or laparoscopic groups. Primary outcomes included serious adverse events, organ space infection (OSI), readmissions, reoperations, and interventions at 30 days. Secondary outcomes included operation length and hospital stay. We performed propensity score matching based on clinically relevant preoperative variables to create balanced groups before analysis. We analyzed our data using separate Cochran-Mantel-Haenszel tests with year as the stratification variable and conducted subgroup analyses for robotic patients only using separate t tests for proportions, with P < .05 denoting statistical significance.
Of the 315,647 patients available for comparison in the 2015 to 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant User Files, there were 41,364 matched in the final data set. Using the Cochran-Mantel-Haenszel test, we found a significant association between year of performance and outcomes for OSI, 30 day-readmission, and intervention. The incidence of OSI after laparoscopic and robotic cases was .3% and .4%, respectively, in 2015 versus .2% and .3%, respectively, in 2017 (P = .04, odds ratio = 1.49). Thirty-day readmission for robotic cases was 5.2% in 2015 and 4.0% in 2017 (P < .05, odds ratio = 1.16). The incidence of 30-day intervention for robotic cases also dropped from 2.2% in 2015 to 1.3% in 2017 (P < .05, odds ratio = 1.37). Using a Student's t test, there was also a statistically significant decrease in serious adverse events in the robotic group between 2015 and 2017 (incidence of serious adverse events in 2015 was 5.2% versus 3.7% in 2017, P < .05). Rate of 30-day reoperation for the robotic group did change over time but was comparable to the laparoscopic group (1.4% versus 1.3%).
Our study showed between 2015 and 2017 the outcomes of robotic bariatric surgery have improved as evidenced by the significant decrease in the rate of OSI, readmissions, and interventions at 30 days.
机器人手术在减重手术中越来越多地被使用，但机器人手术在减重方面的益处仍存在争议。
本研究旨在使用代谢和减重手术认证和质量改进计划数据库，比较 2015 年至 2017 年间机器人减重手术与腹腔镜手术的结果。
美国大学医院。
使用代谢和减重手术认证和质量改进计划数据库，对 2015 年至 2017 年间进行原发性机器人或腹腔镜袖状胃切除术和 Roux-en-Y 胃旁路术的患者进行了研究。患者被分为机器人或腹腔镜组。主要结果包括严重不良事件、器官间隙感染（OSI）、再入院、再次手术和 30 天内干预。次要结果包括手术时间和住院时间。我们根据临床相关术前变量进行倾向评分匹配，在分析前创建平衡组。我们使用 Cochran-Mantel-Haenszel 检验分析我们的数据，以年份作为分层变量，并对机器人患者进行亚组分析，仅使用独立样本 t 检验进行比例分析，P <.05 表示统计学意义。
在 2015 年至 2017 年代谢和减重手术认证和质量改进计划参与者用户文件中，有 315647 名患者可用于比较，最终数据集中有 41364 名患者匹配。使用 Cochran-Mantel-Haenszel 检验，我们发现手术年份与 OSI、30 天再入院和干预的结果之间存在显著关联。腹腔镜和机器人手术后 OSI 的发生率分别为 2015 年的 0.3%和 0.4%，2017 年分别为 0.2%和 0.3%（P =.04，优势比=1.49）。2015 年机器人手术的 30 天再入院率为 5.2%，2017 年为 4.0%（P <.05，优势比=1.16）。机器人手术 30 天干预的发生率也从 2015 年的 2.2%降至 2017 年的 1.3%（P <.05，优势比=1.37）。使用学生 t 检验，2015 年至 2017 年间机器人组的严重不良事件也有统计学显著下降（2015 年严重不良事件的发生率为 5.2%，2017 年为 3.7%，P <.05）。机器人组 30 天再手术的发生率随着时间的推移而变化，但与腹腔镜组相当（1.4%对 1.3%）。
我们的研究表明，2015 年至 2017 年间，机器人减重手术的结果有所改善，证据是 OSI、30 天再入院和干预的发生率显著下降。
