Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 E. 17th Avenue, Aurora, CO, C-31080045, USA.
Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA.
J Robot Surg. 2023 Apr;17(2):365-374. doi: 10.1007/s11701-022-01427-4. Epub 2022 Jun 7.
Robotic thoracic surgery has demonstrated benefits. We aimed to evaluate implementation of a robotic thoracic surgery program on postoperative outcomes at our Veteran's Administration Medical Center (VAMC). We retrospectively reviewed our VAMC database from 2015 to 2021. Patients who underwent surgery with intention to treat lung nodules were included. Primary outcome was patient length of stay (LOS). Patients were grouped by surgical approach and stratified to before and after adoption of robotic surgery. Univariate comparison of postoperative outcomes was performed using Wilcoxon rank sums and chi-squared tests. Multivariate regression was performed to control for ASA class. P values < 0.05 were considered significant. Outcomes of 108 patients were assessed. 63 operations (58%) occurred before and 45 (42%) after robotic surgery implementation. There were no differences in patient preoperative characteristics. More patients underwent minimally invasive surgery (MIS) in the post-implementation era than pre-implementation (85% vs. 42%, p < 0.001). Robotic operations comprised 53% of operations post-implementation. On univariate analysis, patients in the post-implementation era had a shorter LOS vs. pre-implementation, regardless of surgical approach (mean 4.7 vs. 6.0 days, p = 0.04). On multivariate analysis, patients who underwent MIS had a shorter LOS [median 4 days (IQR 2-6 days) vs. 7 days (6-9 days), p < 0.001] and were more likely to be discharged home than to inpatient facilities [OR (95% CI) 13.00 (1.61-104.70), p = 0.02]. Robotic thoracic surgery program implementation at a VAMC decreased patient LOS and increased the likelihood of discharging home. Implementation at other VAMCs may be associated with improvement in some patient outcomes.
机器人辅助胸腔手术具有优势。我们旨在评估退伍军人事务部医疗中心（VAMC）的机器人胸腔手术项目对术后结果的实施情况。我们回顾性分析了 2015 年至 2021 年的 VAMC 数据库。纳入了接受手术治疗肺结节的患者。主要结果是患者的住院时间（LOS）。根据手术方法对患者进行分组，并分层为机器人手术实施前后。使用 Wilcoxon 秩和检验和卡方检验对术后结果进行单变量比较。使用多变量回归来控制 ASA 分级。p 值<0.05 被认为具有统计学意义。评估了 108 例患者的结果。63 例手术（58%）在机器人手术实施前进行，45 例手术（42%）在机器人手术实施后进行。患者术前特征无差异。在实施后时代，接受微创手术（MIS）的患者多于实施前时代（85%比 42%，p<0.001）。在实施后时代，机器人手术占手术总数的 53%。在单变量分析中，无论手术方法如何，实施后时代的患者 LOS 都短于实施前时代（平均 4.7 天与 6.0 天，p=0.04）。在多变量分析中，接受 MIS 的患者 LOS 更短[中位数 4 天（IQR 2-6 天）与 7 天（6-9 天），p<0.001]，更有可能出院回家而不是住院设施[OR（95%CI）13.00（1.61-104.70），p=0.02]。VAMC 实施机器人辅助胸腔手术项目可缩短患者 LOS 并增加出院回家的可能性。在其他 VAMC 实施可能与某些患者结果的改善相关。
