■尽管微创外科(MIS)在许多专业领域都在增长,开放式结肠手术仍常规进行.这项研究的目的是比较开放结肠和微创结肠切除术的结果和成本。
我们使用Vizient®临床数据库分析了2016年1月1日至2018年12月31日之间的结果。人口统计,住院时间,再入院,并发症,死亡率,比较了接受选择性开放和微创结肠切除术的患者的成本。对于双变量分析,连续变量采用Wilcoxon秩和检验,分类变量采用χ2检验。多元Logistic和Quintile回归用于多变量分析。
■对总共88,405例选择性结肠切除术(开放:56,599;微创:31,806)进行了审查。与接受开放手术的患者相比,接受微创手术的患者肥胖比例明显更高(体重指数>30)(71.4%vs.59.6%;p<0.0001)。与微创结肠切除术相比,开腹结肠切除术患者的中位住院时间[中位数(范围):7(4-13)天vs.4(3-6)天,p<0.0001],30天再入院率[n=8557(15.1%)与2815(8.9%),p<0.0001],较高的死亡率[n=2590(4.4%)107(0.34%),p<0.0001],和更高的总直接成本[中位数(范围):$13,582(9041-23,094)与$9013(6748-12,649),p<0.0001]。多变量模型证实了这些发现。
■微创结肠手术在住院时间方面具有明显的益处,再入院率,死亡率和成本,应重新评估开腹结肠切除术的常规使用。
UNASSIGNED: Despite the growth of minimally invasive surgery (MIS) in many specialties, open colon surgery is still routinely performed. The purpose of this study was to compare outcomes and costs between open colon and minimally invasive colon resections.
UNASSIGNED: We analyzed outcomes between January 1, 2016 and December31, 2018 using the Vizient® clinical database. Demographics, hospital length of stay, readmissions, complications, mortality, and costs were compared between patients undergoing elective open and minimally invasive colon resections. For bivariate analysis, Wilcoxon rank-sum test was used for continuous variables and χ2 test was used for categorical variables. Multiple Logistic and Quintile regression were used for multivariable analyses.
UNASSIGNED: A total of 88,405 elective colon resections (open: 56,599; minimally invasive: 31,806) were reviewed. A significantly larger proportion of patients undergoing minimally invasive surgery were obese (body mass index > 30) compared to those undergoing open surgery (71.4% vs. 59.6%; p < 0.0001). As compared to minimally invasive colectomy, open colectomy patients had: a longer median length of stay [median (range): 7 (4-13) days vs. 4 (3 - 6) days, p < 0.0001], higher 30-day readmission rate [n = 8557 (15.1%) vs. 2815 (8.9%), p < 0.0001], higher mortality [n = 2590 (4.4%) vs. 107 (0.34%), p < 0.0001], and a higher total direct cost [median (range): $13,582 (9041-23,094) vs. $9013 (6748 - 12,649), p < 0.0001]. Multivariable models confirmed these findings.
UNASSIGNED: Minimally invasive colon surgery has clear benefits in terms of length of stay, readmission rate, mortality and cost, and the routine use of open colon resection should be revaluated.