Center for Abdominal Core Health, Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center. Columbus, OH.
Department of Surgery Vanderbilt University, Nashville, TN.
Ann Surg. 2023 Apr 1;277(4):697-703. doi: 10.1097/SLA.0000000000005260. Epub 2021 Oct 22.
To describe 30-day outcomes including post-operative complications, readmissions, and quality of life score changes for older adults undergoing elective ventral hernia repair with retromuscular mesh placement and to compare rates of these outcomes for individuals undergoing robotic versus open approaches.
Over one third of patients presenting for elective ventral hernia repair are over the age of 65 and many have complex surgical histories that warrant intricate hernia repairs. Robotic ventral hernia repairs have gained increasing popularity in the US and in some studies have demonstrated decreased rates of postoperative complications, and less pain resulting in shorter hospital stays. However, the robotic approach has several downsides including prolonged operative times as well as the use of pneumo-peritoneum which may be risky in older patients.
We performed a retrospective review of prospectively collected data in a national hernia specific registry (the Abdominal Core Health Quality Collaborative) and identified patients over the age of 65 undergoing either an open or robotic retromuscular ventral hernia repair. After propensity score matching adjusting for demographic, clinical, and hernia related factors, logistic regression was used to compare 30-day complications, readmission, and quality of life (QoL) scores as captured by the HerQLes scale for patients undergoing each approach.
Of 2128 patients who met inclusion criteria, 1695 (79.7%) underwent open ventral hernia repair while 433 (20.3%) underwent robotic repair. After propensity score matching, there were 350 robotic cases and 759 open cases for analysis. Patients undergoing robotic repairs demonstrated significantly shorter length of stays (1 vs 4 days, P < 0.01) and had equivalent odds of both 30-day post-operative complications (odds ratio [OR] 1.15 95% confidence interval 0.92-1.44) and readmission (OR 1.09 95% confidence interval 0.74-1.6) compared to the open approach. QoL scores were similar between groups at 30 days but were slightly better for robotic patients at 1 year (92 vs 84 P < 0.01).
Robotic ventral hernia repair is an option for appropriately selected older patients undergoing retromuscular ventral hernia repair, demonstrating shorter hospital stays and equivalent rates of complications and readmissions in the post-operative period. However, more data is needed regarding QoL outcomes and long-term function, especially as it relates to recurrence rates, between the two approaches.
描述 30 天的结果，包括老年患者接受后入路网片修补术的术后并发症、再入院和生活质量评分变化，并比较机器人手术与开放手术的这些结果发生率。
超过三分之一的择期行腹外疝修补术的患者年龄在 65 岁以上，许多患者有复杂的手术史，需要进行复杂的疝修补术。机器人腹外疝修补术在美国越来越受欢迎，一些研究表明，机器人手术的术后并发症发生率较低，疼痛较轻，住院时间较短。然而，机器人手术有几个缺点，包括手术时间延长以及使用气腹，这可能对老年患者有风险。
我们对一个全国性疝特定登记处（腹部核心健康质量协作组）前瞻性收集的数据进行了回顾性分析，确定了年龄在 65 岁以上接受开放或机器人后入路腹外疝修补术的患者。在调整人口统计学、临床和疝相关因素的倾向评分匹配后，使用逻辑回归比较了两种方法的 30 天并发症、再入院和生活质量（QoL）评分（由 HerQLes 量表评估）。
在符合纳入标准的 2128 名患者中，1695 名（79.7%）接受了开放腹外疝修补术，433 名（20.3%）接受了机器人修补术。在倾向评分匹配后，机器人组有 350 例，开放组有 759 例。接受机器人手术的患者住院时间明显缩短（1 天 vs 4 天，P<0.01），与开放组相比，30 天术后并发症（优势比[OR]1.15，95%置信区间 0.92-1.44）和再入院（OR1.09，95%置信区间 0.74-1.6）的可能性相似。两组在 30 天时的 QoL 评分相似，但机器人组在 1 年时的评分稍好（92 分 vs 84 分，P<0.01）。
对于接受后入路腹外疝修补术的合适老年患者，机器人腹外疝修补术是一种选择，可缩短住院时间，术后并发症和再入院率相似。然而，还需要更多关于 QoL 结果和长期功能的数据，特别是在与两种方法的复发率有关的方面。
