Department of Surgery, Mayo Clinic, Rochester, MN, USA.
The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Surg Endosc. 2024 Oct;38(10):5851-5857. doi: 10.1007/s00464-024-11158-2. Epub 2024 Aug 19.
Studies comparing outcomes between robotic and laparoscopic paraesophageal hernia repairs have yielded conflicting results. We sought to analyze early postoperative complications between these approaches using a newly available NSQIP variable indicating robot use.
We queried the 2022 ACS NSQIP database for adult patients undergoing elective minimally invasive hiatal hernia repair. Chi-squared and Kruskal-Wallis tests were used to compare cohort characteristics. Logistic, linear, and Cox proportional hazards regression analyses were used to compare perioperative outcomes between the laparoscopic and robotic groups.
We identified 4345 patients who underwent repair using a laparoscopic (2778 patients; 63.9%) or robotic (1567 patients; 36.1%) approach. Most (73.1%) were female, and the median age was 65 (IQR 55, 73). Patients who underwent robotic repair were younger (median age 64 vs 66), had a slightly higher body mass index (BMI; median 30.2 vs 29.9), and were more likely to have hypertension (53.0% vs 48.5%), all p < 0.01. On unadjusted analysis the robotic approach was associated with decreased 30-day mortality (0.0% vs 0.4%, p < 0.01). After adjusting for age, gender, race, BMI, and hypertension, the robotic approach was not associated with increased major complications (5.6% vs 5.1%, AOR 1.13, 95% CI 0.86, 1.49), minor complications (0.9% vs 1.5%, AOR 1.20, 95% CI 0.74, 1.93), or unplanned readmission (6.5% vs 5.5%, AHR 1.17, 95% CI 0.89, 1.54), all p ≥ 0.26. After adjusting for age and hypertension, the robotic cohort had an increased risk of myocardial infarction (AOR 2.53, 95% CI 1.01, 6.33, p = 0.048) and pulmonary embolism (AOR 2.76, 95% CI 1.17, 6.49, p = 0.02), although none resulted in 30-day mortality.
Robotic and laparoscopic paraesophageal hernia repairs had similar overall complication and readmission rates. The robotic cohort had an increased risk of myocardial infarction and pulmonary embolism but no 30-day mortality. Current data support the use of both robotic and laparoscopic approaches for paraesophageal hernia repair.
比较机器人和腹腔镜食管裂孔疝修复术结果的研究得出了相互矛盾的结果。我们试图使用新的 NSQIP 变量来分析这些方法之间的早期术后并发症，该变量表明机器人的使用。
我们在 2022 年 ACS NSQIP 数据库中查询了接受择期微创食管裂孔疝修复术的成年患者。使用卡方检验和 Kruskal-Wallis 检验比较队列特征。使用逻辑、线性和 Cox 比例风险回归分析比较腹腔镜组和机器人组的围手术期结局。
我们确定了 4345 名接受腹腔镜（2778 名患者；63.9%）或机器人（1567 名患者；36.1%）方法修复的患者。大多数（73.1%）为女性，中位年龄为 65（IQR 55，73）。接受机器人修复的患者年龄较小（中位年龄 64 岁 vs 66 岁），体重指数（BMI）略高（中位值 30.2 vs 29.9），且高血压（53.0% vs 48.5%）的可能性更高，所有 p 值均<0.01。在未调整的分析中，机器人方法与 30 天死亡率降低相关（0.0% vs 0.4%，p 值<0.01）。在调整年龄、性别、种族、BMI 和高血压后，机器人方法与主要并发症增加无关（5.6% vs 5.1%，AOR 1.13，95%CI 0.86，1.49）、次要并发症（0.9% vs 1.5%，AOR 1.20，95%CI 0.74，1.93）或计划外再入院（6.5% vs 5.5%，AHR 1.17，95%CI 0.89，1.54），所有 p 值均≥0.26。在调整年龄和高血压后，机器人组心肌梗死的风险增加（AOR 2.53，95%CI 1.01，6.33，p 值=0.048）和肺栓塞（AOR 2.76，95%CI 1.17，6.49，p 值=0.02），尽管均无 30 天死亡率。
机器人和腹腔镜食管裂孔疝修复术的总体并发症和再入院率相似。机器人组心肌梗死和肺栓塞的风险增加，但 30 天死亡率没有增加。目前的数据支持使用机器人和腹腔镜方法进行食管裂孔疝修复。
