Department of Surgery, Loyola University Medical Center, Maywood, IL; Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL.
Department of Surgery, University of South Florida, Tampa, FL; OnetoMap Analytics, University of South Florida, Tampa, FL.
J Am Coll Surg. 2021 Jul;233(1):9-19.e2. doi: 10.1016/j.jamcollsurg.2021.05.003. Epub 2021 May 17.
Published studies evaluating the effect of robotic assistance on clinical outcomes and costs of care in diaphragmatic hernia repair (DHR) have been limited.
The Healthcare Cost and Utilization Project State Inpatient and State Ambulatory Surgery and Services Databases for Florida were queried to identify patients undergoing transabdominal DHR between 2011 and 2018 and associated inpatient and outpatient encounters within 12 months after the index operation. Patients undergoing robotic DHR were 1:1:1 propensity score-matched for age, sex, race, Elixhauser comorbidity score, case priority, payer, and facility volume with patients undergoing open and laparoscopic DHR.
There were 5,962 patients (67.3%) who underwent laparoscopic DHR, 1,520 (17.2%) who underwent open DHR, and 1,376 (15.5%) who underwent robotic DHR. On comparison of matched cohorts, median index length of stay (3 days; interquartile range [IQR] 2 to 5 days vs 2 days; IQR 1 to 4 days; p < 0.001) and index hospitalization costs ($17,236; IQR $13,231 to $22,183 vs $12,087; IQR $8,881 to $17,439; p < 0.001) for robotic DHR were greater than for laparoscopic DHR. Median length of stay for open DHR (6 days; IQR 4 to 10 days) was longer than that for both laparoscopic and robotic DHR. Median index hospitalization costs for open DHR ($16,470; IQR $11,152 to $23,768) were greater than those for laparoscopic DHR, but less than those for robotic DHR. There were no significant differences between cohorts in the overall rate of post-index care.
Laparoscopic DHR is the most cost-effective approach to DHR. Robotic assistance provides clinical outcomes comparable with laparoscopic DHR, but is associated with increased index cost.
评估机器人辅助在膈疝修补术 (DHR) 中的临床效果和护理成本的已发表研究有限。
通过查询佛罗里达州医疗保健成本和利用项目州住院和州门诊手术和服务数据库，确定了 2011 年至 2018 年间接受经腹 DHR 的患者，并在索引手术后 12 个月内对相关住院和门诊就诊进行了调查。对接受机器人 DHR 的患者按照年龄、性别、种族、Elixhauser 合并症评分、病例优先级、付款人和设施量进行 1:1:1 倾向评分匹配，与接受开放和腹腔镜 DHR 的患者进行匹配。
有 5962 例（67.3%）患者接受腹腔镜 DHR，1520 例（17.2%）接受开放 DHR，1376 例（15.5%）接受机器人 DHR。在比较匹配队列时，机器人 DHR 的中位索引住院时间（3 天；四分位距 [IQR] 2 至 5 天）和索引住院费用（17236 美元；IQR 13231 至 22183 美元）大于腹腔镜 DHR（2 天；IQR 1 至 4 天；p<0.001）。开放 DHR 的中位住院时间（6 天；IQR 4 至 10 天）长于腹腔镜和机器人 DHR。开放 DHR 的中位索引住院费用（16470 美元；IQR 11152 至 23768 美元）高于腹腔镜 DHR，但低于机器人 DHR。在索引后护理的总发生率方面，各队列之间无显著差异。
腹腔镜 DHR 是 DHR 最具成本效益的方法。机器人辅助与腹腔镜 DHR 具有相当的临床效果，但与更高的指数成本相关。
