Department of Surgery, Veterans Affairs Medical Center, 50 Irving St. NW, Washington, DC, 20422, USA.
Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.
Hernia. 2022 Jun;26(3):889-899. doi: 10.1007/s10029-021-02419-3. Epub 2021 Apr 28.
Robotic inguinal hernia repair (RHR) is an evolving technique but is comparatively expensive and has yet to show superior outcomes versus open (OHR) or laparoscopic (LHR) approaches. The utilization and clinical outcomes of RHR have not been reported within the veterans affairs (VA) system. This study analyzes trends in utilization and 30-day post-operative outcomes between OHR, LHR, and RHR in veterans.
This is a retrospective review of patients that underwent inguinal herniorrhaphy using the Veterans Affairs Quality Improvement Program database. Multivariable analysis of outcomes was performed adjusting for pre-operative confounding covariates between OHR, LHR, and RHR. Trends in utilization, complication rates, and operative times were also reported.
From 2008-2019, 124,978 cases of inguinal herniorrhaphy were identified: 100,880 (80.7%) OHR, 18,035 (14.4%) LHR, and 6063 (4.9%) RHR. Compared to LHR, RHR was associated with 4.94 times higher odds of complications, 100 min longer mean operative time, and 1.5 days longer median length of stay (LOS). Compared to OHR, RHR was associated with 5.92 times higher odds of complications, 57 min longer mean operative time, and 1.1 days longer median LOS. Utilization of RHR and LHR significantly increased over time. RHR complication rates decreased over time (2008: 20.8% to 2019: 3.2%) along with mean operative times (2008: 4.9 h to 2019: 2.8 h; p < 0.05).
While this study demonstrated inferior outcomes after RHR, the temporal trends are encouraging. This may be due to increased surgeon experience with robotics. Further prospective data will elucidate the role of RHR as this technique increases.
机器人腹股沟疝修补术（RHR）是一种不断发展的技术，但与开放式（OHR）或腹腔镜（LHR）方法相比，其成本相对较高，且尚未显示出更好的结果。RHR 在退伍军人事务部（VA）系统内的使用情况和临床结果尚未报告。本研究分析了退伍军人中 OHR、LHR 和 RHR 的使用情况和 30 天术后结果的趋势。
这是一项使用退伍军人事务部质量改进计划数据库对接受腹股沟疝修补术的患者进行的回顾性研究。对 OHR、LHR 和 RHR 之间的术前混杂协变量进行多变量分析，以调整结果。还报告了使用趋势、并发症发生率和手术时间。
2008 年至 2019 年，共确定了 124978 例腹股沟疝修补术病例：100880 例（80.7%）为 OHR，18035 例（14.4%）为 LHR，6063 例（4.9%）为 RHR。与 LHR 相比，RHR 发生并发症的几率高 4.94 倍，手术时间长 100 分钟，中位住院时间（LOS）长 1.5 天。与 OHR 相比，RHR 发生并发症的几率高 5.92 倍，手术时间长 57 分钟，中位 LOS 长 1.1 天。RHR 和 LHR 的使用率随着时间的推移显著增加。RHR 的并发症发生率随着时间的推移而降低（2008 年：20.8%至 2019 年：3.2%），手术时间也随之缩短（2008 年：4.9 小时至 2019 年：2.8 小时；p<0.05）。
虽然本研究表明 RHR 后结果较差，但随着时间的推移，趋势令人鼓舞。这可能是由于机器人手术经验的增加。随着这项技术的普及，进一步的前瞻性数据将阐明 RHR 的作用。
