Department of Surgery, Thomas Jefferson University, 211 S 9th Street, Suite 402, Philadelphia, PA, 19107, USA.
Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA.
Surg Endosc. 2021 Dec;35(12):7209-7218. doi: 10.1007/s00464-020-08211-1. Epub 2021 Jan 4.
This study aimed to examine the perioperative outcomes of robotic inguinal hernia repair as compared to the open and laparoscopic approaches utilizing large-scale population-level data.
This study was funded by the SAGES Robotic Surgery Research Grant (2019). The New York Statewide Planning and Research Cooperative System (SPARCS) administrative database was used to identify all adult patients undergoing initial open (O-IHR), laparoscopic (L-IHR), and robotic (R-IHR) inguinal hernia repair between 2010 and 2016. Perioperative outcome measures [complications, length of stay (LOS), 30-day emergency department (ED) visits, 30-day readmissions] and estimated 1/3/5-year recurrence incidences were compared. Propensity score (PS) analysis was used to estimate marginal differences between R-IHR and L-IHR or O-IHR, using a 1:1 matching algorithm.
During the study period, a total of 153,727 patients underwent inguinal hernia repair (117,603 [76.5%] O-IHR, 35,565 [23.1%] L-IHR; 559 [0.36%] R-IHR) in New York state. Initial univariate analysis found R-IHR to have longer LOS (1.74 days vs. 0.66 O-IHR vs 0.19 L-IHR) and higher rates of overall complications (9.3% vs. 3.6% O-IHR vs 1.1% L-IHR), 30-day ED visits (11.6% vs. 6.1% O-IHR vs. 4.9% L-IHR), and 30-day readmissions (5.6% vs. 2.4% O-IHR vs. 1.2% L-IHR) (p < 0.0001). R-IHR was associated with higher recurrence compared to L-IHR. Following PS analysis, there were no differences in perioperative outcomes between R-IHR and L-IHR, and the difference in recurrence was found to be sensitive to possible unobserved confounding factors. R-IHR had significantly lower risk of complications (Risk difference - 0.09, 95% CI [- 0.13, - 0.056]; p < 0.0001) and shorter LOS (Ratio 0.53, 95% CI [0.45, 0.62]; p < 0.0001) compared to O-IHR.
In adult patients, R-IHR may be associated with comparable to more favorable 30-day perioperative outcomes as compared with L-IHR and O-IHR, respectively.
本研究旨在利用大规模人群水平数据，比较机器人腹股沟疝修补术与开放和腹腔镜方法的围手术期结果。
本研究由 SAGES 机器人手术研究资助（2019 年）。利用纽约州全州规划和研究合作系统（SPARCS）行政数据库，确定 2010 年至 2016 年间所有初次行开放（O-IHR）、腹腔镜（L-IHR）和机器人（R-IHR）腹股沟疝修补术的成年患者。比较围手术期结果[并发症、住院时间（LOS）、30 天急诊（ED）就诊、30 天再入院]和估计的 1/3/5 年复发率。使用倾向评分（PS）分析，使用 1:1 匹配算法，估计 R-IHR 与 L-IHR 或 O-IHR 之间的边际差异。
在研究期间，纽约州共有 153727 例患者接受了腹股沟疝修补术（117603[76.5%]行 O-IHR、35565[23.1%]行 L-IHR、559[0.36%]行 R-IHR）。初步单变量分析发现，R-IHR 的 LOS 较长（1.74 天 vs.0.66 O-IHR vs.0.19 L-IHR），总体并发症发生率较高（9.3% vs.3.6% O-IHR vs.1.1% L-IHR），30 天 ED 就诊率（11.6% vs.6.1% O-IHR vs.4.9% L-IHR）和 30 天再入院率（5.6% vs.2.4% O-IHR vs.1.2% L-IHR）（p<0.0001）。与 L-IHR 相比，R-IHR 与更高的复发率相关。在 PS 分析后，R-IHR 与 L-IHR 之间的围手术期结局无差异，且复发差异对可能存在的未观察到的混杂因素敏感。与 O-IHR 相比，R-IHR 的并发症风险显著降低（风险差异-0.09，95%CI[-0.13，-0.056]；p<0.0001），LOS 更短（比值 0.53，95%CI[0.45，0.62]；p<0.0001）。
在成年患者中，与 O-IHR 相比，R-IHR 可能与更有利的 30 天围手术期结果相关，与 L-IHR 相比则相似。
