BACKGROUND We used a population-based database to: (1) compare clinical and economic outcomes between minimally invasive surgery (MIS) and open surgery (OS) for colectomy; and (2) evaluate contemporary trends in MIS rates. METHODS Retrospective Premier Healthcare Database review of patients undergoing elective inpatient colectomy between January 1, 2010 and September 30, 2017 (first = index admission). Patients were classified into MIS (laparoscopic/robotic) or OS groups, and by left or right colectomy. Propensity score matching (1:1 ratio) of MIS and OS groups was used to address potential confounding from patient/hospital/provider characteristics. Study outcomes, measured during index admission, included major perioperative complications [anastomotic leak (AL), bleeding, infection, and a composite of infection/AL], operating room time (ORT), length of stay (LOS), and total hospital costs. RESULTS Among 134,970 study-eligible patients, MIS rates increased from ~ 2% (2010) to 19-23% (2017), driven by a > tenfold increase in robotic surgery. The matched MIS and OS colectomy groups comprised 46,708 (left) and 44,560 (right) total patients. Risks of AL, bleeding, and infection were lower for MIS versus OS (all p < 0.001). In left: AL occurred in 7.9% of MIS versus 9.9% of OS; bleeding 7.8% versus 9.7%; infection 3.3% versus 5.8%; infection/AL 9.8% versus 13.3%. In right: AL 8.9% versus 11.1%; bleeding 9.8% versus 10.8%; infection 3.0% versus 5.1%; infection/AL 10.5% versus 10.4%. Although ORTs were longer with MIS (left: 240.8 vs. 216.2 min; right: 192.8 vs. 178.0 min), LOS was shorter (left: 5.4 vs. 7.1 days; right: 5.5 vs. 7.1 days), and total hospital costs were lower (left: $18,564 vs. $19,960; right: $17,375 vs. $19,417) versus OS (all p < 0.001). CONCLUSIONS Compared with OS, MIS was associated with significantly lower risk of major perioperative complications (including AL), lower LOS, and lower total hospital costs, despite longer OR times. MIS colectomy rates have increased over time; recent gains appear to be due to uptake of robotic surgery.

中文翻译：

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与开放手术相比，微创结肠切除术与减少吻合口漏和其他主要围手术期并发症的风险以及减少医院资源的利用有关：一项基于人群的回顾性研究，比较了手术方法的有效性和趋势。

背景技术我们使用基于人群的数据库来：（1）比较用于结肠切除术的微创手术（MIS）和开放手术（OS）之间的临床和经济结果；（2）评价MIS率的当代趋势。方法对2010年1月1日至2017年9月30日进行择期住院结肠切除术的患者进行回顾性Premier医疗数据库回顾（首次=入院）。根据左或右结肠切除术将患者分为MIS组（腹腔镜/机器人）或OS组。MIS组和OS组的倾向得分匹配（1：1比率）用于解决患者/医院/提供者特征带来的潜在混淆。纳入指标期间测得的研究结果包括主要围手术期并发症[解剖学渗漏（AL），出血，感染以及感染/ AL的复合物]，手术室时间（ORT），住院时间（LOS）和总住院费用。结果在134,970名符合研究条件的患者中，由于机器人手术的增加>十倍，MIS率从〜2％（2010）增至19-23％（2017）。匹配的MIS和OS结肠切除术组包括46708名（左）和44,560名（右）患者。MIS组与OS组相比，AL，出血和感染的风险更低（所有p <0.001）。左：AL发生在MIS的7.9％，OS发生的9.9％；出血7.8％对9.7％; 感染率分别为3.3％和5.8％；感染/ AL为9.8％，而AL为13.3％。右图：AL 8.9％对11.1％；出血9.8％对10.8％; 感染率分别为3.0％和5.1％；感染/ AL为10.5％，而10.4％。尽管MIS的ORT较长（左：240.8 vs. 216.2分钟;右：192.8 vs. 178.0分钟），LOS较短（左：5.4 vs. 7.1天;右：5.5 vs. 7.1天），总住院费用为较低（左：$ 18，564对比$ 19,960; 右：$ 17,375 vs. $ 19,417）vs OS（all p <0.001）。结论与OS相比，尽管手术时间更长，但MIS与重大围手术期并发症（包括AL），更低的LOS和更低的总住院费用的风险显着相关。MIS结肠切除率随时间增加；最近的进展似乎是由于机器人手术的应用。