机器人与开放式腹疝修补术的临床结果和成本比较。

A comparison of clinical outcomes and costs between robotic and open ventral hernia repair.

机构信息

Good Samaritan Medical Center, Brockton, MA, USA; Tufts University School of Medicine, Boston, MA, USA.

Good Samaritan Medical Center, Brockton, MA, USA.

出版信息

Am J Surg. 2023 Jul;226(1):87-92. doi: 10.1016/j.amjsurg.2023.01.031. Epub 2023 Feb 1.

DOI:10.1016/j.amjsurg.2023.01.031

PMID:36740503

Abstract

BACKGROUND

As robotic ventral hernia repair(VHR) adoption increases, real-world evidence is needed to ensure appropriate utilization.

METHODS

Data for open and robotic VHR(OVHR, RVHR) was retrospectively analyzed. Outcomes and costs were compared via inverse probability treatment weighting using propensity scores to estimate the average treatment effect on the treated for RVHR.

RESULTS

675 open and 609 robotic ventral hernia repairs were included. Demographics and hernia characteristics were comparable. Complications rates were lower in RVHR(p < 0.001). Clavien-Dindo grade-III complications were lower in RVHR(13.2% vs. 4.9%, p < 0.001). RVHR resulted in fewer surgical site events(21.5% vs. 12.2%, p < 0.001). Recurrence rates were greater in OVHR(8.9% vs. 2.8%, p < 0.001). The higher RVHR hospital costs (Δ = $2456, p = 0.005) were balanced by the lower post-discharge costs, compared to OVHR(Δ = $799, p = 0.023). Total costs did not differ(Δ = $1656 p = 0.081).

CONCLUSION

Although hospital costs were higher, post-discharge expenses favored RVHR due to the lower postoperative complications, which lead to comparable total costs to OVHR.

摘要

背景

随着机器人腹侧疝修补术（VHR）的应用增加，需要真实世界的证据来确保其合理利用。

方法

回顾性分析了开放和机器人 VHR（OVHR、RVHR）的数据。使用倾向评分进行逆概率治疗加权，通过比较治疗效果来评估 RVHR 的效果。

结果

共纳入 675 例开放 VHR 和 609 例机器人 VHR。患者的人口统计学和疝特征具有可比性。RVHR 的并发症发生率较低（p<0.001）。Clavien-Dindo 分级 III 级并发症的发生率较低（13.2%比 4.9%，p<0.001）。RVHR 导致的手术部位事件较少（21.5%比 12.2%，p<0.001）。OVHR 的复发率较高（8.9%比 2.8%，p<0.001）。虽然 RVHR 的医院费用较高（Δ=2456 美元，p=0.005），但与 OVHR 相比，RVHR 的出院后费用较低（Δ=799 美元，p=0.023）。总费用没有差异（Δ=1656 美元，p=0.081）。