Section of Colon & Rectal Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, WACC 460, Boston, MA, USA.
Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Surg Endosc. 2022 Oct;36(10):7549-7560. doi: 10.1007/s00464-022-09189-8. Epub 2022 Apr 21.
As the US healthcare system moves towards value-based care, hospitals have increased efforts to improve quality and reduce unnecessary resource use. Surgery is one of the most resource-intensive areas of healthcare and we aim to compare health resource utilization between open and minimally invasive cancer procedures.
We retrospectively analyzed cancer patients who underwent colon resection, rectal resection, lobectomy, or radical nephrectomy within the Premier hospital database between 2014 and 2019. Study outcomes included length of stay (LOS), discharge status, reoperation, and 30-day readmission. The open surgical approach was compared to minimally invasive approach (MIS), with subgroup analysis of laparoscopic/video-assisted thoracoscopic surgery (LAP/VATS) and robotic (RS) approaches, using inverse probability of treatment weighting.
MIS patients had shorter LOS compared to open approach: - 1.87 days for lobectomy, - 1.34 days for colon resection, - 0.47 days for rectal resection, and - 1.21 days for radical nephrectomy (all p < .001). All MIS procedures except for rectal resection are associated with higher discharge to home rates and lower reoperation and readmission rates. Within MIS, robotic approach was further associated with shorter LOS than LAP/VATS: - 0.13 days for lobectomy, - 0.28 days for colon resection, - 0.67 days for rectal resection, and - 0.33 days for radical nephrectomy (all p < .05) and with equivalent readmission rates.
Our data demonstrate a significant shorter LOS, higher discharge to home rate, and lower rates of reoperation and readmission for MIS as compared to open procedures in patients with lung, kidney, and colorectal cancer. Patients who underwent robotic procedures had further reductions in LOS compare to laparoscopic/video-assisted thoracoscopic approach, while the reductions in LOS did not lead to increased rates of readmission.
随着美国医疗保健系统向基于价值的医疗保健转变，医院已加大力度提高质量并减少不必要的资源使用。手术是医疗保健中资源最密集的领域之一，我们旨在比较开放手术和微创癌症手术之间的卫生资源利用情况。
我们回顾性分析了 2014 年至 2019 年期间 Premier 医院数据库中接受结肠切除术、直肠切除术、肺叶切除术或根治性肾切除术的癌症患者。研究结果包括住院时间（LOS）、出院状态、再次手术和 30 天内再入院。将开放手术方法与微创方法（MIS）进行比较，对腹腔镜/电视辅助胸腔镜手术（LAP/VATS）和机器人（RS）方法进行亚组分析，使用治疗反概率加权。
与开放手术相比，MIS 患者的 LOS 更短：肺叶切除术为-1.87 天，结肠切除术为-1.34 天，直肠切除术为-0.47 天，根治性肾切除术为-1.21 天（均 p < .001）。除直肠切除术外，所有 MIS 手术均与更高的出院回家率和更低的再次手术和再入院率相关。在 MIS 中，机器人手术与 LAP/VATS 相比，LOS 进一步缩短：肺叶切除术为-0.13 天，结肠切除术为-0.28 天，直肠切除术为-0.67 天，根治性肾切除术为-0.33 天（均 p < .05），并且再入院率相当。
我们的数据表明，与开放手术相比，MIS 患者的 LOS 显著缩短，出院回家率更高，肺、肾和结直肠癌患者的再次手术和再入院率更低。与腹腔镜/电视辅助胸腔镜手术相比，接受机器人手术的患者的 LOS 进一步缩短，而 LOS 的缩短并未导致再入院率增加。
