机器人辅助与开放手术治疗大型腹疝的比较——使用ACHQC数据库对30天结局的多中心分析
A comparison between robotic-assisted and open approaches for large ventral hernia repair-a multicenter analysis of 30 days outcomes using the ACHQC database.
作者信息
Lima Diego L, Nogueira Raquel, Ma Jianing, Jalloh Mohamad, Keisling Shannon, Saleh Adel Alhaj, Sreeramoju Prashanth
机构信息
Department of Surgery, Montefiore Medical Center, New York, NY, USA.
Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
出版信息
Surg Endosc. 2024 Dec;38(12):7538-7543. doi: 10.1007/s00464-024-11249-0. Epub 2024 Sep 16.
INTRODUCTION
Over the last few decades, there has been an increase in the use of a minimally invasive (MIS) approach for complex hernias involving component separation. A robotic platform provides better visualization and mobilization of tissues for component separation. We aim to assess the outcomes of open and robotic-assisted approaches for large VHR utilizing the ACHQC national database.
METHODS
A retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative (ACHQC) was performed to include all adult patients who had primary and incisional midline ventral hernias larger than 10 cm and underwent elective open and robotic hernia repairs with mesh from January 2013 to March 2023. Univariate and multivariate analyses were performed comparing Open and Robotic approaches.
RESULTS
The ACHQC database identified 5,516 patients with midline hernias larger than 10 cm who underwent VHR. The open group (OG) had 4,978 patients, and the robotic group (RG) had 538. The RG had a higher median BMI (33.3 kg/m (IQR 29.8-38.1) vs 32.7 (IQR 28.7-36.6) (p < 0.001). Median hernia width was 15 cm (IQR 12-18) in the OG and 12 cm in the RG (10-14) (p < 0.001). Sublay positioning of the mesh was the most common. The fascial closure was higher in the RG (524; 97% versus 4,708; 95%-p = 0.005). Median Length of Stay (LOS) was 5 days (IQR 4-7) in the OG and 2 days (IQR 1-3) in the RG (p < 0.001). The readmission rate was higher in the OG (n = 374; 7.5% vs n = 16; 3%; p < 0.001). 30-day SSI were higher in the OG (343; 6.9%% vs 14; 2.6%; p < 0.001). Logistic regression analysis identified diabetes (OR 1.6; CI 1.1-2.1; p = 0.006) and BMI (OR 1.04, CI 1.02-1.06; p < 0.001) as predictors of SSIs, while the robotic approach was protective (OR 0.35, CI 0.17-0.64; p = 0.002). For SSO, logistic regression showed BMI (OR 1.04, CI 1.03-1.06; p < 0.001) and smoking (OR 1.8, CI 1.3-2.4; p < 0.001) as predictors Robotic approach was associated with lower readmission rates (OR .04, CI 0.2-0.6; p < 0.001).
CONCLUSION
A robotic approach improves early 30-day outcomes compared to an open technique for large VHR. There was no difference in SSO at 30 days.
引言
在过去几十年中，对于涉及组织分离的复杂疝，微创（MIS）方法的使用有所增加。机器人平台为组织分离提供了更好的可视化和组织游离效果。我们旨在利用ACHQC国家数据库评估开放性和机器人辅助方法治疗大型腹直肌后鞘前筋膜缺损（VHR）的效果。
方法
对前瞻性收集的来自腹部核心健康质量协作组（ACHQC）的数据进行回顾性分析，纳入2013年1月至2023年3月期间所有患有原发性和切口性中线腹疝且疝环直径大于10 cm，并接受择期开放性和机器人疝修补术并使用补片的成年患者。对开放性和机器人辅助方法进行单因素和多因素分析。
结果
ACHQC数据库识别出5516例疝环直径大于10 cm并接受VHR手术的患者。开放组（OG）有4978例患者，机器人组（RG）有538例。RG组的中位体重指数（BMI）更高（33.3 kg/m²（四分位间距IQR 29.8 - 38.1）vs 32.7（IQR 28.7 - 36.6）（p < 0.001））。OG组疝的中位宽度为15 cm（IQR 12 - 18），RG组为12 cm（10 - 14）（p < 0.001）。补片置于腹横筋膜下是最常见的方式。RG组的筋膜闭合率更高（524例；97% 对比4708例；95% - p = 0.005）。OG组的中位住院时间（LOS）为5天（IQR 4 - 7），RG组为2天（IQR 1 - 3）（p < 0.001）。OG组的再入院率更高（n = 374例；7.5% 对比n = 16例；3%；p < 0.001）。OG组的30天手术部位感染（SSI）率更高（343例；6.9% 对比14例；2.6%；p < 0.001）。逻辑回归分析确定糖尿病（比值比OR 1.6；可信区间CI 1.1 - 2.1；p = 0.006）和BMI（OR 1.04，CI 1.02 - 1.06；p < 0.001）为SSI的预测因素，而机器人辅助方法具有保护作用（OR 0.35，CI 0.17 - 0.64；p = 0.002）。对于手术部位器官/腔隙感染（SSO），逻辑回归显示BMI（OR 1.04，CI 1.03 - 1.06；p < 0.001）和吸烟（OR 1.8，CI 1.3 - 2.4；p < 0.001）为预测因素。机器人辅助方法与较低的再入院率相关（OR 0.4，CI 0.2 - 0.6；p < 0.001）。
结论
与开放性技术相比，机器人辅助方法可改善大型VHR患者术后30天的早期预后。30天时SSO无差异。
Zotero 插件