背景:比较机器人和腹腔镜食管旁疝修补术结果的研究得出了相互矛盾的结果。我们试图使用新可用的指示机器人使用的NSQIP变量来分析这些方法之间的早期术后并发症。
方法:我们查询了2022年ACSNSQIP数据库中接受择期微创食管裂孔疝修补术的成年患者。卡方检验和Kruskal-Wallis检验用于比较队列特征。物流,线性,和Cox比例风险回归分析用于比较腹腔镜组和机器人组的围手术期结局.
结果:我们确定了4345例采用腹腔镜(2778例;63.9%)或机器人(1567例;36.1%)方法进行修复的患者。大多数(73.1%)是女性,年龄中位数为65岁(IQR55,73)。接受机器人修复的患者年龄较小(中位年龄64vs66),体重指数略高(BMI;中位数30.2vs29.9),并且更容易患高血压(53.0%vs48.5%),所有p<0.01。在未经调整的分析中,机器人方法与30天死亡率降低相关(0.0%vs0.4%,p<0.01)。在调整了年龄之后,性别,种族,BMI,和高血压,机器人方法与主要并发症的增加无关(5.6%vs5.1%,AOR1.13,95%CI0.86,1.49),轻微并发症(0.9%vs1.5%,AOR1.20,95%CI0.74,1.93),或计划外再入院(6.5%对5.5%,AHR1.17,95%CI0.89,1.54),所有p≥0.26。在调整了年龄和高血压后,机器人队列的心肌梗死(AOR2.53,95%CI1.01,6.33,p=0.048)和肺栓塞(AOR2.76,95%CI1.17,6.49,p=0.02)的风险增加,尽管没有导致30天死亡。
结论:机器人和腹腔镜食管旁疝修补术具有相似的总体并发症和再入院率。机器人队列增加了心肌梗死和肺栓塞的风险,但没有30天的死亡率。当前数据支持使用机器人和腹腔镜方法进行食管旁疝修复。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.