Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (ANM, JDV, KMM).
John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (NHY, GJH).
Hawaii J Health Soc Welf. 2021 Nov;80(11 Suppl 3):3-9.
Robotic-assisted surgery has become a desired modality for performing colectomy; however, unplanned conversion to an open procedure may be associated with worse outcomes. The purpose of this study is to examine predictors and consequences of unplanned conversion to open in a large, high fidelity data set. A retrospective analysis of 11 061 robotic colectomies was conducted using the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) 2012-2017 database. Predictors of conversion and the effect of conversion on outcomes were analyzed by multivariate logistic regression resulting in risk-adjusted odds ratios of conversion and morbidity/mortality. Overall, 10 372 (93.8%) patients underwent successful robotic colectomy, and 689 (6.2%) had an unplanned conversion. Predictors of conversion included age ≥ 65 years, male gender, obesity, functional status not independent, American Society of Anesthesia (ASA) classification IV-V, non-oncologic indication, emergency case, smoking, recent weight loss, bleeding disorder, and preoperative organ space infection. Conversion is an independent risk factor for mortality, overall morbidity, cardiac morbidity, pulmonary morbidity, renal morbidity, venous thromboembolism morbidity, wound morbidity, sepsis, bleeding, readmission, return to the operating room, and extended length of stay (LOS). Unplanned conversion to open during robotic colectomy is an independent predictor of morbidity and mortality.
机器人辅助手术已成为进行结肠切除术的理想方式；然而，计划外转为开放手术可能与更差的结果相关。本研究的目的是在一个大型、高保真数据集中检查计划外转为开放的预测因素和后果。使用美国外科医师学会-国家手术质量改进计划 (ACS-NSQIP) 2012-2017 数据库对 11061 例机器人结肠切除术进行回顾性分析。通过多变量逻辑回归分析转换的预测因素以及转换对结果的影响，得出转换的风险调整比值比和发病率/死亡率。总体而言，10372 例（93.8%）患者成功进行了机器人结肠切除术，689 例（6.2%）患者计划外转为开放手术。转换的预测因素包括年龄≥65 岁、男性、肥胖、功能状态不独立、美国麻醉医师协会 (ASA) 分类 IV-V、非肿瘤适应证、急症、吸烟、近期体重减轻、出血障碍和术前器官空间感染。转换是死亡率、总发病率、心脏发病率、肺部发病率、肾脏发病率、静脉血栓栓塞发病率、伤口发病率、败血症、出血、再入院、返回手术室和延长住院时间（LOS）的独立危险因素。机器人结肠切除术中计划外转为开放是发病率和死亡率的独立预测因素。
