Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Depatment of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Am Surg. 2024 Oct;90(10):2649-2655. doi: 10.1177/00031348241256065. Epub 2024 May 20.
Despite increasing use of minimally invasive surgical (MIS) techniques for trauma, limited large-scale studies have evaluated trends, outcomes, and resource utilization at centers that utilize MIS modalities for blunt abdominal trauma.
Operative adult admissions after blunt assault, falls, or vehicular collisions were tabulated from the 2016-2020 National Inpatient Sample. Patients who received diagnostic laparoscopy or other laparoscopic and robotic intervention were classified as MIS. Institutions with at least one MIS trauma operation in a year were defined as an MIS Performing Institution (MPI; rest: non-MPI). The primary endpoint was mortality, with secondary outcomes of reoperation, complication, postoperative length of stay (LOS), and hospitalization costs. Mixed regression models were used to determine the association of MPI status on the outcomes of interest.
Throughout the study period, the proportion of MIS operations and MPI significantly increased from 22.6 to 29.8% and 45.9 to 58.8%, respectively. Of an estimated 77,480 patients, 66.7% underwent care at MPI. After adjustment, MPI status was not associated with increased odds of mortality (adjusted odds ratio [AOR] 1.09, 95% confidence interval [CI] [.96,1.24]), reoperation (AOR 1.02, CI [.87,1.19]), or any of the tabulated complications. There was additionally no difference in adjusted LOS (β-.18, CI [-.85, +.49]) or costs (β+$1600, CI [-1600, +4800]), between MPI and non-MPI.
The use of MIS operations in blunt abdominal trauma has significantly increased, with performing centers experiencing no difference in mortality or resource utilization. Prospectively collected data on outcomes following MIS trauma surgery is necessary to elucidate appropriate applications.
尽管微创外科 (MIS) 技术在创伤中的应用越来越多，但很少有大规模的研究评估在使用 MIS 方式治疗钝性腹部创伤的中心的趋势、结果和资源利用情况。
从 2016 年至 2020 年国家住院患者样本中列出了因钝性攻击、跌倒或车辆碰撞而接受手术的成年患者。接受诊断性腹腔镜检查或其他腹腔镜和机器人干预的患者被归类为 MIS。在一年内至少进行一次 MIS 创伤手术的机构被定义为 MIS 执行机构 (MPI; 其余为非 MPI)。主要终点是死亡率，次要结果是再次手术、并发症、术后住院时间 (LOS) 和住院费用。混合回归模型用于确定 MPI 状态对感兴趣结果的关联。
在整个研究期间，MIS 手术和 MPI 的比例从 22.6%显著增加到 29.8%和 45.9%增加到 58.8%。在估计的 77480 名患者中，66.7%在 MPI 接受治疗。调整后，MPI 状态与死亡率增加无关（调整后的优势比 [AOR] 1.09，95%置信区间 [CI] [.96,1.24]）、再次手术（AOR 1.02，CI [.87,1.19]）或列出的任何并发症。MPI 和非 MPI 之间的调整 LOS（β-.18，CI [-.85，+.49]）或成本（β+$1600，CI [-1600，+4800]）也没有差异。
在钝性腹部创伤中使用 MIS 手术的比例显著增加，而执行中心在死亡率或资源利用方面没有差异。需要前瞻性收集 MIS 创伤手术后的结果数据，以阐明其适当的应用。
