National trends and outcomes of robotic emergency general surgery in the United States.

Autor: Charland N; David Geffen School of Medicine at UCLA, Los Angeles, CA., Hadaya J; David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA., Mallick S; David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA., Tran Z; David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Surgery, Loma Linda University Health, Loma Linda, CA., Cho NY; David Geffen School of Medicine at UCLA, Los Angeles, CA., Le N; David Geffen School of Medicine at UCLA, Los Angeles, CA., Kim S; David Geffen School of Medicine at UCLA, Los Angeles, CA., Mukherjee K; Department of Surgery, Loma Linda University Health, Loma Linda, CA., Benharash P; David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: Pbenharash@mednet.ucla.edu.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2024 Sep; Vol. 176 (3), pp. 835-840. Date of Electronic Publication: 2024 Jun 24.
DOI: 10.1016/j.surg.2024.05.002
Abstrakt: Background: Robot-assisted surgery has seen exponential adoption over the last decade. Although the safety and efficacy of robotic surgery in the elective setting have been demonstrated, data regarding robotic emergency general surgery remains sparse.
Methods: All adults undergoing non-elective appendectomy, cholecystectomy, small or large bowel resection, perforated ulcer repair, or lysis of adhesions were identified in the 2008 to 2020 National Inpatient Sample. Temporal trends were analyzed using a rank-based, non-parametric test developed by Cuzick (nptrend). Using laparoscopy as a reference, multivariable regressions were used to evaluate the association between robotic techniques and in-hospital mortality, major complications, and resource use for each emergency general surgery operation.
Results: Of an estimated 4,040,555 patients undergoing emergency general surgery, 65,853 (1.6%) were performed using robotic techniques. The robotic proportion of minimally invasive emergency general surgery increased significantly overall, with the largest growth seen in robot-assisted large bowel resections and perforated ulcer repairs. After adjustment for various patient and hospital-level factors, robot-assisted large bowel resection (adjusted odds ratio 0.73, 95% confidence interval 0.58-0.91) and cholecystectomy (adjusted odds ratio 0.66, 95% confidence interval 0.55-0.81) were associated with significantly reduced odds of perioperative blood transfusion compared to traditional laparoscopy. Although robotic techniques were associated with modest reductions in postoperative length of stay, costs were uniformly higher by increments of up to $4,900.
Conclusion: Robotic surgery appears to be a safe and effective adjunct to laparoscopy in minimally invasive emergency general surgery, although comparable cost-effectiveness has yet to be realized. Increasing use of robotic techniques in emergency general surgery may be attributable in part to reduced complications, including blood loss, in certain operative contexts.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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