Abstract：
BACKGROUND: Associations between procedure volumes and outcomes can inform minimum volume standards and the regionalization of health services. Robot-assisted surgery continues to expand globally; however, data are limited regarding which hospitals should be using the technology.
METHODS: Using administrative health data for all residents of Ontario, Canada, this retrospective cohort study included adult patients who underwent a robot-assisted radical prostatectomy (RARP), total robotic hysterectomy (TRH), robot-assisted partial nephrectomy (RAPN), or robotic portal lobectomy using 4 arms (RPL-4) between January 2010 and September 2021. Associations between yearly hospital volumes and 90-day major complications were evaluated using multivariable logistic regression models adjusted for patient characteristics and clustering at the level of the hospital.
RESULTS: A total of 10,879 patients were included, with 7567, 1776, 724, and 812 undergoing a RARP, TRH, RAPN, and RPL-4, respectively. Yearly hospital volume was not associated with 90-day complications for any procedure. Doubling of yearly volume was associated with a 17-min decrease in operative time for RARP (95% confidence interval [CI] - 23 to - 10), 8-min decrease for RAPN (95% CI - 14 to - 2), 24-min decrease for RPL-4 (95% CI - 29 to - 19), and no significant change for TRH (- 7 min; 95% CI - 17 to 3).
CONCLUSIONS: The risk of 90-day major complications does not appear to be higher in low volume hospitals; however, they may not be as efficient with operating room utilization. Careful case selection may have contributed to the lack of an observed association between volumes and complications.
METHODS: Using administrative health data for all residents of Ontario, Canada, this retrospective cohort study included adult patients who underwent a robot-assisted radical prostatectomy (RARP), total robotic hysterectomy (TRH), robot-assisted partial nephrectomy (RAPN), or robotic portal lobectomy using 4 arms (RPL-4) between January 2010 and September 2021. Associations between yearly hospital volumes and 90-day major complications were evaluated using multivariable logistic regression models adjusted for patient characteristics and clustering at the level of the hospital.
RESULTS: A total of 10,879 patients were included, with 7567, 1776, 724, and 812 undergoing a RARP, TRH, RAPN, and RPL-4, respectively. Yearly hospital volume was not associated with 90-day complications for any procedure. Doubling of yearly volume was associated with a 17-min decrease in operative time for RARP (95% confidence interval [CI] - 23 to - 10), 8-min decrease for RAPN (95% CI - 14 to - 2), 24-min decrease for RPL-4 (95% CI - 29 to - 19), and no significant change for TRH (- 7 min; 95% CI - 17 to 3).
CONCLUSIONS: The risk of 90-day major complications does not appear to be higher in low volume hospitals; however, they may not be as efficient with operating room utilization. Careful case selection may have contributed to the lack of an observed association between volumes and complications.
摘要：
背景：程序量和结果之间的关联可以为最低量标准和卫生服务的区域化提供信息。机器人辅助手术在全球范围内继续扩展；然而，关于哪些医院应该使用这项技术的数据有限。
方法：使用安大略省所有居民的行政健康数据，加拿大,这项回顾性队列研究包括接受机器人辅助前列腺癌根治术（RARP）的成年患者，全机器人子宫切除术（TRH），机器人辅助肾部分切除术(RAPN),或在2010年1月至2021年9月之间使用4臂（RPL-4）进行机器人门静脉肺叶切除术。使用根据患者特征和医院级别的聚类调整的多变量逻辑回归模型评估了年医院数量与90天主要并发症之间的关联。
结果：共纳入10,879例患者，7567、1776、724和812正在进行RARP，TRH,RAPN,和RPL-4。每年的住院时间与任何手术的90天并发症无关。年体积增加一倍与RARP手术时间减少17分钟相关（95％置信区间[CI]-23至-10），RAPN下降8分钟(95%CI-14至-2)，RPL-4下降24分钟(95%CI-29至-19)，TRH无显著变化(-7分钟；95%CI-17至3)。
结论：低容量医院发生90天主要并发症的风险似乎并不高；然而，它们在手术室利用率方面可能没有那么有效。仔细的病例选择可能导致体积和并发症之间缺乏观察到的关联。
方法：使用安大略省所有居民的行政健康数据，加拿大,这项回顾性队列研究包括接受机器人辅助前列腺癌根治术（RARP）的成年患者，全机器人子宫切除术（TRH），机器人辅助肾部分切除术(RAPN),或在2010年1月至2021年9月之间使用4臂（RPL-4）进行机器人门静脉肺叶切除术。使用根据患者特征和医院级别的聚类调整的多变量逻辑回归模型评估了年医院数量与90天主要并发症之间的关联。
结果：共纳入10,879例患者，7567、1776、724和812正在进行RARP，TRH,RAPN,和RPL-4。每年的住院时间与任何手术的90天并发症无关。年体积增加一倍与RARP手术时间减少17分钟相关（95％置信区间[CI]-23至-10），RAPN下降8分钟(95%CI-14至-2)，RPL-4下降24分钟(95%CI-29至-19)，TRH无显著变化(-7分钟；95%CI-17至3)。
结论：低容量医院发生90天主要并发症的风险似乎并不高；然而，它们在手术室利用率方面可能没有那么有效。仔细的病例选择可能导致体积和并发症之间缺乏观察到的关联。
