Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, CA.
Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, CA; Department of Surgery, Harbor University of California Los Angeles, Torrance, CA.
Surgery. 2020 Oct;168(4):625-630. doi: 10.1016/j.surg.2020.06.018. Epub 2020 Aug 3.
Laparoscopic cholecystectomy has reached nearly universal adoption in the management of gallstone-related disease. With advances in operative technology, robotic-assisted cholecystectomy has been used increasingly in many practices, but few studies have examined the adoption of robotic assistance for inpatient cholecystectomy and the temporal outcomes on a national scale. The present study aimed to identify trends in utilization, as well as outcomes and factors associated with the use of robotic-assisted cholecystectomy.
The 2008 to 2017 database of the National Inpatient Sample was used to identify patients undergoing inpatient cholecystectomy. Independent predictors of the use of robotic assistance for cholecystectomy were identified using multivariable logistic regression adjusting for patient and hospital characteristics.
Of an estimated 3,193,697 patients undergoing cholecystectomy, 98.7% underwent laparoscopic cholecystectomy and 1.3% robotic-assisted cholecystectomy. Rates of robotic-assisted cholecystectomy increased from 0.02% in 2008 to 3.2% in 2017 (nptrend < .001). Compared with laparoscopic cholecystectomy, patients undergoing robotic-assisted cholecystectomy had a greater burden of comorbidities as measured by the Elixhauser index (2.2 vs 1.9, P < .001). Although mortality rates were similar, robotic-assisted cholecystectomy was associated with greater complication rates (15.5% vs 11.7%, P < .001), most notably gastrointestinal-related complications (3.7% vs 1.5%, P < .001). On multivariable regression, robotic-assisted cholecystectomy was associated with increased costs of hospitalization (β: $2,398, P < .001).
Using the largest national database available, we found a dramatic increase in the use of robotic-assisted cholecystectomy with no difference in mortality or duration of hospital stay, but there was a statistically significant increase in complications and costs. These findings warrant further investigation.
腹腔镜胆囊切除术在治疗胆石相关疾病的管理中已得到广泛应用。随着手术技术的进步，机器人辅助胆囊切除术已在许多实践中越来越多地使用，但很少有研究检查机器人辅助住院胆囊切除术的采用情况以及全国范围内的时间结果。本研究旨在确定利用情况以及与使用机器人辅助胆囊切除术相关的结果和因素。
使用 2008 年至 2017 年国家住院患者样本数据库确定接受住院胆囊切除术的患者。使用多变量逻辑回归识别胆囊切除术使用机器人辅助的独立预测因素，并调整患者和医院特征。
在估计有 3193697 例接受胆囊切除术的患者中，98.7%接受了腹腔镜胆囊切除术，1.3%接受了机器人辅助胆囊切除术。机器人辅助胆囊切除术的比例从 2008 年的 0.02%增加到 2017 年的 3.2%（nptrend <.001）。与腹腔镜胆囊切除术相比，接受机器人辅助胆囊切除术的患者的合并症负担更大，以 Elixhauser 指数衡量（2.2 比 1.9，P <.001）。虽然死亡率相似，但机器人辅助胆囊切除术与更高的并发症发生率相关（15.5%比 11.7%，P <.001），特别是胃肠道相关并发症（3.7%比 1.5%，P <.001）。在多变量回归中，机器人辅助胆囊切除术与住院费用增加相关（β：$2398，P <.001）。
使用最大的可用国家数据库，我们发现机器人辅助胆囊切除术的使用急剧增加，死亡率或住院时间没有差异，但并发症和成本呈统计学显著增加。这些发现值得进一步调查。
