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微创肝切除术与开腹肝切除术的临床和经济结局比较：倾向评分匹配分析。

Comparison of clinical and economic outcomes between minimally invasive liver resection and open liver resection: a propensity-score matched analysis.

机构信息

Epidemiology, Medical Devices, Johnson and Johnson, New Brunswick, NJ, USA.

出版信息

HPB (Oxford). 2021 May;23(5):785-794. doi: 10.1016/j.hpb.2020.09.017. Epub 2020 Oct 10.

DOI:10.1016/j.hpb.2020.09.017

PMID:33046367

Abstract

BACKGROUND

Minimally invasive liver resection (MILR) has gained momentum in recent years. This study of contemporary data compares economic and clinical outcomes between MILR and open liver resection (OLR).

METHODS

We extracted data for patients undergoing liver resection between October 2015-September 2018 from the Premier Healthcare Database. We conducted a propensity score matched analysis to compare complications, in-hospital mortality, inpatient readmissions, discharge to institutional post-acute care, operating room time (ORT), length of stay (LOS), and total hospital cost between MILR and OLR patients.

RESULTS

From the eligible OLR (n = 3349) and MILR (n = 1367) patients, we propensity score matched 1261 from each cohort at a 1:1 ratio. After matching, MILR was associated with lower rates of complications (bleeding: 8.2% vs. 17.4%; respiratory failure: 5.5% vs. 10.9%; intestinal obstruction: 3.6% vs. 6.0%, and pleural effusion: 1.9% vs. 4.9%), in-hospital mortality (0.5% vs. 3.0%), 90-day inpatient readmissions (10.4% vs. 14.3%), discharge to institutional post-acute care (6.9% vs. 12.3%), shorter ORT (257 vs. 308 min) and LOS (4.3 vs. 7.2 days), and lower hospital costs ($19463 vs. $29119) (all P < 0.001).

CONCLUSION

MILR was associated with lower risk of complications and reduced hospital resource utilizations as compared with OLR.

摘要

背景

近年来，微创肝切除术（MILR）得到了迅猛发展。本项基于当代数据的研究比较了 MILR 和开腹肝切除术（OLR）的经济学和临床结局。

方法

我们从 Premier Healthcare Database 中提取了 2015 年 10 月至 2018 年 9 月期间接受肝切除术的患者数据。我们采用倾向评分匹配分析比较了 MILR 和 OLR 患者的并发症、院内死亡率、再入院、出院至机构康复后护理、手术室时间（ORT）、住院时间（LOS）和总住院费用。

结果

在符合条件的 OLR（n=3349）和 MILR（n=1367）患者中，我们以 1:1 的比例对每个队列的 1261 例患者进行了倾向评分匹配。匹配后，MILR 与较低的并发症发生率相关（出血：8.2% vs. 17.4%；呼吸衰竭：5.5% vs. 10.9%；肠梗阻：3.6% vs. 6.0%，和胸腔积液：1.9% vs. 4.9%）、院内死亡率（0.5% vs. 3.0%）、90 天内再入院率（10.4% vs. 14.3%）、出院至机构康复后护理（6.9% vs. 12.3%）、较短的 ORT（257 分钟 vs. 308 分钟）和 LOS（4.3 天 vs. 7.2 天），以及较低的住院费用（$19463 美元 vs. $29119 美元）（均 P < 0.001）。