机器人辅助与传统腹腔镜子宫切除术并发骶阴道固定术的手术并发症和医院费用:全国再入院数据库分析

Sarah E Andiman, Anthony H Bui, Charles Ascher-Walsh, Jason D Wright, Xiao Xu
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引用次数: 4

摘要

目的:尽管越来越多地使用机器人技术进行微创子宫切除术和骶髋固定术,但支持这些昂贵手术益处的证据仍不确定。本研究旨在通过一个大型国家数据库,比较机器人辅助和传统腹腔镜子宫切除术并发骶阴道固定术的围手术期并发症、30天再入院和成本的差异。方法:使用2009-2015年全国再入院数据库和程序代码,我们确定了接受机器人辅助或传统腹腔镜子宫切除术合并骶colpop固定术的患者。我们使用诊断和程序代码测量院内围手术期并发症,并根据住院期间的患者联系测量30天再入院率。使用收费和收费成本比估算医院费用。使用双变量和多变量回归分析比较机器人辅助和传统腹腔镜手术的结果。结果:我们的加权样本共包括7675名患者。6.7%的机器人辅助和11.2%的传统腹腔镜手术发生了主要的围手术期并发症(未经调整P < 0.001;校正优势比为0.69;95%置信区间为0.51-0.93;P = 0.02)。机器人辅助腹腔镜手术的住院费用高于传统腹腔镜手术(平均费用分别为16,367美元和13,898美元;P < 0.001),调整后的成本比为1.24(95%置信区间为1.17-1.31;P < 0.001)。30天再入院的风险在机器人辅助和传统腹腔镜手术之间相似。结论:具有全国代表性的数据表明,在腹腔镜子宫切除术合并骶髋固定术中,机器人辅助入路与传统入路相比,尽管成本较高,但围手术期并发症的风险较低。30天再入院的风险在机器人辅助和传统腹腔镜方法之间是相似的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Surgical Complications and Hospital Costs in Robot-Assisted Versus Conventional Laparoscopic Hysterectomy With Concurrent Sacrocolpopexy: Analysis of the Nationwide Readmissions Database.

Objectives: Despite increasing use of robotic technology for minimally invasive hysterectomy with sacrocolpopexy, evidence supporting the benefits of these costly procedures remains inconclusive. This study aimed to compare differences in perioperative complications, 30-day readmissions, and costs between robot-assisted and conventional laparoscopic hysterectomy with concurrent sacrocolpopexy using a large national database.

Methods: Using the 2009-2015 Nationwide Readmissions Database and procedure codes, we identified patients who underwent a robot-assisted or conventional laparoscopic hysterectomy with sacrocolpopexy. We measured in-hospital perioperative complications using diagnosis and procedure codes and measured 30-day readmissions based on patient linkages across hospitalizations. Hospital costs were estimated using charges and cost-to-charge ratios. These outcomes were compared between robot-assisted and conventional laparoscopic procedures using bivariate and multivariable regression analysis.

Results: Our weighted sample included a total of 7,675 patients. Major perioperative complications occurred in 6.7% of robot-assisted and 11.2% of conventional laparoscopic procedures (unadjusted P < 0.001; adjusted odds ratio, 0.69; 95% confidence interval, 0.51-0.93; P = 0.02). Hospital costs were higher in robot-assisted than in conventional laparoscopic procedures (respective median costs, $16,367 vs $13,898; P < 0.001), with an adjusted cost ratio of 1.24 (95% confidence interval, 1.17-1.31; P < 0.001). The risk of 30-day readmission was similar between robot-assisted and conventional laparoscopic procedures.

Conclusions: Nationally representative data suggest that, in laparoscopic hysterectomy with sacrocolpopexy, the robot-assisted approach is associated with a lower risk of perioperative complications, despite higher costs, compared with the conventional one. The risk of 30-day readmission was similar between the robot-assisted and conventional laparoscopic approaches.

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