Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
J Surg Res. 2024 Oct;302:166-174. doi: 10.1016/j.jss.2024.07.036. Epub 2024 Aug 3.
Minimally invasive lung resection has been associated with improved outcomes; however, institutional characteristics associated with utilization are unclear. We hypothesized that the presence of surgical robots at institutions would be associated with increased utilization of minimally invasive techniques .
Patients with cT1/2N0M0 non-small cell lung cancer who underwent lung lobectomy between 2010 and 2020 in the National Cancer Database were identified. Patients were categorized by operative approach as minimally invasive surgery (MIS) versus open. Institutions were categorized as "high utilizers" of MIS technique if their proportion of MIS lobectomies was >50%. Multivariate logistic regressions were used to determine factors associated with proportion of procedures performed minimally invasively. Further multivariate models were used to evaluate the association of proportion of MIS procedures with 90-d mortality, hospital length of stay, and hospital readmission.
In multivariate analysis, passage of time by year (odds ratio [OR] 1.26; confidence interval [CI] 1.22-1.30) and presence of a robot at the facility (OR 3.48; CI 2.84-4.24) were associated with high MIS-utilizing facilities. High utilizers of MIS were associated with lower 90-d mortality (OR 0.89; CI 0.83-0.97) and hospital length of stay (coeff -0.88; CI -1.03 to -0.72). Hospital readmission was similar between high and low MIS-utilizing facilities (compared to low MIS-utilizing facilities: OR 1.06; CI 0.95-1.09).
Passage of time and the presence of surgical robots were independently associated with increased utilization of MIS lobectomy. In addition to being associated with improved patient-level outcomes, robotic surgery is correlated with a higher proportion of procedures being performed minimally invasively.
微创肺切除术与改善结果相关；然而，利用的机构特征尚不清楚。我们假设机构中存在手术机器人会与微创技术的应用增加相关。
在国家癌症数据库中，确定了 2010 年至 2020 年间接受肺叶切除术的 cT1/2N0M0 非小细胞肺癌患者。患者根据手术方法分为微创外科 (MIS) 与开放手术。如果 MIS 肺叶切除术的比例>50%，则机构被归类为 MIS 技术的“高利用者”。使用多变量逻辑回归确定与微创程序比例相关的因素。进一步的多变量模型用于评估 MIS 程序比例与 90 天死亡率、住院时间和医院再入院的关联。
在多变量分析中，时间推移（每增加 1 年，比值比 [OR] 1.26；置信区间 [CI] 1.22-1.30）和机构中存在机器人（OR 3.48；CI 2.84-4.24）与高 MIS 利用率机构相关。MIS 的高利用率与较低的 90 天死亡率（OR 0.89；CI 0.83-0.97）和住院时间（系数-0.88；CI-1.03 至-0.72）相关。高 MIS 利用率与低 MIS 利用率机构之间的医院再入院率相似（与低 MIS 利用率机构相比：OR 1.06；CI 0.95-1.09）。
时间推移和手术机器人的存在与 MIS 肺叶切除术利用率的增加独立相关。除了与改善患者水平的结果相关外，机器人手术还与更高比例的微创程序相关。
