目的:关于腹腔镜还是开腹手术技术对于腹股沟疝修补术的优势,争论越来越多。对于嵌顿和绞窄的腹股沟疝,腹腔镜方法仍存在争议.这项研究旨在成为第一个全国范围内的分析,以比较急诊情况下腹腔镜和开放式腹股沟疝修补术之间的临床和医疗保健利用结果。
方法:对全国住院患者样本进行回顾性分析。纳入2015年10月至2019年12月接受腹腔镜腹股沟疝修补术(LIHR)和开放式腹股沟疝修补术(OIHR)的所有患者。主要结果是死亡率,次要结果包括术后并发症,入住ICU,停留时间(LOS)和总入场费。使用单变量和多变量逻辑和线性回归比较了两种方法。
结果:在2015年至2019年之间,纳入了17,205例患者。其中,213名患者接受了LIHR,16,992名患者接受了OIHR。腹腔镜和开腹手术死亡率无差异(比值比[OR]0.80,95%CI[0.25,2.61],p=0.714)。此外,术后ICU入院组间无显著差异(OR1.11,95%CI[0.74,1.67],p=0.614),术后并发症(OR1.09,95%CI[0.76,1.56],p=0.647),LOS(平均差[MD]:-0.02天,95%CI[-0.56,0.52],p=0.934),或总入场费(MD:$3,028.29,95%CI[$-110.94,$6167.53],p=0.059)。
结论:腹腔镜腹股沟疝修补术与开放式腹股沟疝修补术相比,发病率低,死亡率和医疗资源利用率。
There has been a growing debate of whether laparoscopic or open surgical techniques are superior for inguinal hernia repair. For incarcerated and
strangulated inguinal hernias, the laparoscopic approach remains controversial. This study aims to be the first nationwide analysis to compare clinical and healthcare utilization outcomes between laparoscopic and open inguinal hernia repair in an emergency setting.
A retrospective analysis of the National Inpatient Sample was performed. All patients who underwent laparoscopic inguinal hernia repair (LIHR) and open inguinal hernia repair (OIHR) between October 2015 and December 2019 were included. The primary outcome was mortality, and secondary outcomes include post-operative complications, ICU admission, length of stay (LOS), and total admission cost. Two approaches were compared using univariate and multivariate logistic and linear regression.
Between the years 2015 and 2019, 17,205 patients were included. Among these, 213 patients underwent LIHR and 16,992 underwent OIHR. No difference was observed between laparoscopic and open repair for mortality (odds ratio [OR] 0.80, 95% CI [0.25, 2.61], p = 0.714). Additionally, there was no significant difference between groups for post-operative ICU admission (OR 1.11, 95% CI [0.74, 1.67], p = 0.614), post-operative complications (OR 1.09, 95% CI [0.76, 1.56], p = 0.647), LOS (mean difference [MD]: -0.02 days, 95% CI [- 0.56, 0.52], p = 0.934), or total admission cost (MD: $3,028.29, 95% CI [$- 110.94, $6167.53], p = 0.059).
Laparoscopic inguinal hernia repair is comparable to the open inguinal hernia repair with respect to low rates of morbidity, mortality as well as healthcare resource utilization.