Department of Surgery, Cleveland Clinic Center for Abdominal Core Health Cleveland Clinic Foundation, Cleveland, OH, USA.
Department of Surgery, The Ohio State University, Columbus, OH, USA.
Hernia. 2023 Apr;27(2):409-413. doi: 10.1007/s10029-022-02696-6. Epub 2022 Oct 28.
Drains may be placed during robotic retromuscular ventral hernia repair (rVHR) to decrease wound morbidity, but their use is controversial. We aimed to assess the impact of retromuscular drain placement on wound morbidity after robotic rVHR.
Patients with and without drains after robotic rVHR in the Abdominal Core Health Quality Collaborative (ACHQC) registry were compared using a propensity score-matched analysis. Outcomes included surgical site occurrences (SSO), surgical site infections (SSI), and surgical site occurrences requiring procedural interventions (SSOPI) at 30 days.
Propensity score matching compared 580 patients with drains to 580 without drains. The groups were well matched with respect to hernia width (drain: 8.0 cm [IQR 6.0; 10.0] vs no drain: 8.0 cm [IQR 5.0; 10.0]; P = 0.399) and transversus abdominis release (drain: 409 (70.5%) vs no drain: 408 (70.3%); P = 0.949). At 30 days, patients with drains had fewer seromas than those without drains (22 (3.8%) vs 88 (15.2%); P < 0.0001). Rates of SSIs and SSOPIs were similar between the two groups at 30 days. Logistic regression analysis showed drain placement lowered the risk of an SSO compared to no drain placement (OR 0.32, CI 0.21-0.47; P < 0.0001). Hospital stay was longer for patients with drains than those without drains (2.0 days [IQR 1.0; 3.0] vs 1.0 day [IQR 1.0; 2.0], respectively; P < .0001).
Drain placement during robotic rVHR is associated with decreased postoperative seroma occurrence.
在机器人辅助腹横筋膜后入路修补术（rVHR）中，引流管的放置可以降低伤口发病率，但这种做法存在争议。本研究旨在评估机器人辅助 rVHR 后引流管放置对伤口发病率的影响。
我们使用倾向评分匹配分析比较了 Abdominal Core Health Quality Collaborative（ACHQC）注册研究中机器人 rVHR 术后放置引流管和未放置引流管的患者。主要观察指标为术后 30 天的手术部位并发症（SSO）、手术部位感染（SSI）和需要手术干预的手术部位并发症（SSOPI）。
倾向评分匹配比较了 580 例放置引流管的患者和 580 例未放置引流管的患者。两组在疝宽度（引流管组：8.0cm [IQR 6.0；10.0] vs 未引流管组：8.0cm [IQR 5.0；10.0]；P=0.399）和腹横肌松解（引流管组：409 例[70.5%] vs 未引流管组：408 例[70.3%]；P=0.949）方面匹配良好。术后 30 天，放置引流管的患者血清肿发生率低于未放置引流管的患者（22 例[3.8%] vs 88 例[15.2%]；P<0.0001）。两组在术后 30 天的 SSI 和 SSOPI 发生率相似。Logistic 回归分析显示，与未放置引流管相比，放置引流管降低了 SSO 的风险（OR 0.32，CI 0.21-0.47；P<0.0001）。放置引流管的患者住院时间长于未放置引流管的患者（2.0 天[IQR 1.0；3.0] vs 1.0 天[IQR 1.0；2.0]；P<0.0001）。
机器人辅助 rVHR 中引流管的放置与术后血清肿发生率降低有关。
