Department of Surgery, University of Southern California, Los Angeles, CA. Electronic address: https://twitter.com/hiro_m_bj8.
Department of Surgery, University of Southern California, Los Angeles, CA.
Surgery. 2024 Nov;176(5):1366-1373. doi: 10.1016/j.surg.2024.07.029. Epub 2024 Aug 22.
Despite the increasing use of minimally invasive surgeries, the outcome benefits of adopting minimally invasive surgery for colostomy reversal remain unclear. We aimed to analyze nationwide trends in the use of minimally invasive surgery for colostomy reversal and compare patient outcomes between different surgical approaches.
The National Inpatient Sample was queried for patients who underwent colostomy reversal for benign disease from 2015 to 2021. National trends in the use of minimally invasive surgery for colostomy reversal were analyzed by Cochran-Armitage tests. Multivariable linear and logistic regressions accounting for hospital sample weights were developed to examine the association between operative approach (open, laparoscopic, and robotic) and patient outcomes, including hospital complications, length of stay, and hospital charges.
A total of 23,260 patients underwent colostomy reversal: 18,880 (81.2%) open, 3,245 (14.0%) laparoscopic, and 1,135 (4.9%) robotic surgery. From 2015 to 2021, the proportion of robotic approaches increased >5-fold (range 2.1-12.5%; P < .001), whereas the increase in laparoscopic approaches was not significant (range 11.5-16.2%; P = .34). Multivariable analysis showed that the laparoscopic approach was associated with a lower incidence of pulmonary complications (adjusted odds ratio, 0.49; 95% confidence interval, 0.28-0.87), surgical-site infection (odds ratio, 0.37; 95% CI, 0.19-0.72), peritonitis/abdominal abscess (odds ratio, 0.45; 95% confidence interval, 0.26-0.78), and paralytic ileus (odds ratio, 0.67; 95% confidence interval, 0.48-0.92). The robotic approach was associated with a lower incidence of paralytic ileus (odds ratio, 0.58; 95% confidence interval, 0.33-0.99). Laparoscopic and robotic approaches were associated with 22.9% and 29.9% shorter length of stay, respectively. The robotic approach was associated with 33.0% greater hospital charge.
This study observed a significant trend toward the increased use of robotics in colostomy reversal and potential clinical benefits with minimally invasive surgery. Robotic colostomy reversal, along with laparoscopic approach, may provide better postoperative recovery compared with the open approach; however, the utility of robotic surgeries needs to be reevaluated in the future, given the limited clinical benefits despite greater hospital charges.
尽管微创手术的应用日益增多，但采用微创手术进行肠造口还纳的获益结果仍不明确。我们旨在分析全国范围内微创手术用于肠造口还纳的应用趋势，并比较不同手术方法的患者结局。
本研究通过 Cochran-Armitage 检验，分析了 2015 年至 2021 年间因良性疾病接受肠造口还纳术的患者的国家住院患者样本。采用多变量线性和逻辑回归，根据医院样本权重，评估手术方法（开放、腹腔镜和机器人）与患者结局（包括医院并发症、住院时间和住院费用）之间的关联。
共 23260 例患者接受了肠造口还纳术：18880 例（81.2%）为开放手术，3245 例（14.0%）为腹腔镜手术，1135 例（4.9%）为机器人手术。2015 年至 2021 年，机器人手术的比例增加了 5 倍以上（范围 2.1%至 12.5%；P<0.001），而腹腔镜手术的比例增加并不显著（范围 11.5%至 16.2%；P=0.34）。多变量分析显示，腹腔镜手术与较低的肺部并发症发生率（校正优势比，0.49；95%置信区间，0.28-0.87）、手术部位感染（比值比，0.37；95%置信区间，0.19-0.72）、腹膜炎/腹腔脓肿（比值比，0.45；95%置信区间，0.26-0.78）和麻痹性肠梗阻（比值比，0.67；95%置信区间，0.48-0.92）有关。机器人手术与较低的麻痹性肠梗阻发生率（比值比，0.58；95%置信区间，0.33-0.99）有关。腹腔镜和机器人手术分别与住院时间缩短 22.9%和 29.9%有关。机器人手术与 33.0%的更高住院费用有关。
本研究观察到肠造口还纳术应用机器人技术的显著趋势，以及微创手术的潜在临床获益。与开放手术相比，机器人和腹腔镜肠造口还纳术可能提供更好的术后恢复，但鉴于尽管住院费用较高，但机器人手术的临床获益有限，未来需要重新评估机器人手术的实用性。
