Robotic Technology in Emergency General Surgery Cases in the Era of Minimally Invasive Surgery

Although robotic surgery has become an established approach for a wide range of elective operations, data on its utility and outcomes are limited in the setting of emergency general surgery. To describe temporal trends in the use of laparoscopic and robotic approaches and compare outcomes between ro...

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Veröffentlicht in:JAMA surgery Jg. 159; H. 5; S. 493
Hauptverfasser: Lunardi, Nicole, Abou-Zamzam, Aida, Florecki, Katherine L, Chidambaram, Swathikan, Shih, I-Fan, Kent, Alistair J, Joseph, Bellal, Byrne, James P, Sakran, Joseph V
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 01.05.2024
Schlagworte:
Acute Care Surgery
Adult
Aged
Cholecystectomy - methods
Cholecystectomy - statistics & numerical data
Colectomy - methods
Conversion to Open Surgery - statistics & numerical data
Emergencies
Female
Hernia, Inguinal - surgery
Hernia, Ventral - surgery
Herniorrhaphy - methods
Humans
Laparoscopy
Length of Stay - statistics & numerical data
Male
Middle Aged
Minimally Invasive Surgical Procedures
Retrospective Studies
Robotic Surgical Procedures - statistics & numerical data
United States
United States
ISSN:2168-6262, 2168-6262
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Abstract Although robotic surgery has become an established approach for a wide range of elective operations, data on its utility and outcomes are limited in the setting of emergency general surgery. To describe temporal trends in the use of laparoscopic and robotic approaches and compare outcomes between robotic and laparoscopic surgery for 4 common emergent surgical procedures. A retrospective cohort study of an all-payer discharge database of 829 US facilities was conducted from calendar years 2013 to 2021. Data analysis was performed from July 2022 to November 2023. A total of 1 067 263 emergent or urgent cholecystectomies (n = 793 800), colectomies (n = 89 098), inguinal hernia repairs (n = 65 039), and ventral hernia repairs (n = 119 326) in patients aged 18 years or older were included. Surgical approach (robotic, laparoscopic, or open) to emergent or urgent cholecystectomy, colectomy, inguinal hernia repair, or ventral hernia repair. The primary outcome was the temporal trend in use of each operative approach (laparoscopic, robotic, or open). Secondary outcomes included conversion to open surgery and length of stay (both total and postoperative). Temporal trends were measured using linear regression. Propensity score matching was used to compare secondary outcomes between robotic and laparoscopic surgery groups. During the study period, the use of robotic surgery increased significantly year-over-year for all procedures: 0.7% for cholecystectomy, 0.9% for colectomy, 1.9% for inguinal hernia repair, and 1.1% for ventral hernia repair. There was a corresponding decrease in the open surgical approach for all cases. Compared with laparoscopy, robotic surgery was associated with a significantly lower risk of conversion to open surgery: cholecystectomy, 1.7% vs 3.0% (odds ratio [OR], 0.55 [95% CI, 0.49-0.62]); colectomy, 11.2% vs 25.5% (OR, 0.37 [95% CI, 0.32-0.42]); inguinal hernia repair, 2.4% vs 10.7% (OR, 0.21 [95% CI, 0.16-0.26]); and ventral hernia repair, 3.5% vs 10.9% (OR, 0.30 [95% CI, 0.25-0.36]). Robotic surgery was associated with shorter postoperative lengths of stay for colectomy (-0.48 [95% CI, -0.60 to -0.35] days), inguinal hernia repair (-0.20 [95% CI, -0.30 to -0.10] days), and ventral hernia repair (-0.16 [95% CI, -0.26 to -0.06] days). While robotic surgery is still not broadly used for emergency general surgery, the findings of this study suggest it is becoming more prevalent and may be associated with better outcomes as measured by reduced conversion to open surgery and decreased length of stay.
AbstractList Although robotic surgery has become an established approach for a wide range of elective operations, data on its utility and outcomes are limited in the setting of emergency general surgery.ImportanceAlthough robotic surgery has become an established approach for a wide range of elective operations, data on its utility and outcomes are limited in the setting of emergency general surgery.To describe temporal trends in the use of laparoscopic and robotic approaches and compare outcomes between robotic and laparoscopic surgery for 4 common emergent surgical procedures.ObjectivesTo describe temporal trends in the use of laparoscopic and robotic approaches and compare outcomes between robotic and laparoscopic surgery for 4 common emergent surgical procedures.A retrospective cohort study of an all-payer discharge database of 829 US facilities was conducted from calendar years 2013 to 2021. Data analysis was performed from July 2022 to November 2023. A total of 1 067 263 emergent or urgent cholecystectomies (n = 793 800), colectomies (n = 89 098), inguinal hernia repairs (n = 65 039), and ventral hernia repairs (n = 119 326) in patients aged 18 years or older were included.Design, Setting, and ParticipantsA retrospective cohort study of an all-payer discharge database of 829 US facilities was conducted from calendar years 2013 to 2021. Data analysis was performed from July 2022 to November 2023. A total of 1 067 263 emergent or urgent cholecystectomies (n = 793 800), colectomies (n = 89 098), inguinal hernia repairs (n = 65 039), and ventral hernia repairs (n = 119 326) in patients aged 18 years or older were included.Surgical approach (robotic, laparoscopic, or open) to emergent or urgent cholecystectomy, colectomy, inguinal hernia repair, or ventral hernia repair.ExposureSurgical approach (robotic, laparoscopic, or open) to emergent or urgent cholecystectomy, colectomy, inguinal hernia repair, or ventral hernia repair.The primary outcome was the temporal trend in use of each operative approach (laparoscopic, robotic, or open). Secondary outcomes included conversion to open surgery and length of stay (both total and postoperative). Temporal trends were measured using linear regression. Propensity score matching was used to compare secondary outcomes between robotic and laparoscopic surgery groups.Main Outcomes and MeasuresThe primary outcome was the temporal trend in use of each operative approach (laparoscopic, robotic, or open). Secondary outcomes included conversion to open surgery and length of stay (both total and postoperative). Temporal trends were measured using linear regression. Propensity score matching was used to compare secondary outcomes between robotic and laparoscopic surgery groups.During the study period, the use of robotic surgery increased significantly year-over-year for all procedures: 0.7% for cholecystectomy, 0.9% for colectomy, 1.9% for inguinal hernia repair, and 1.1% for ventral hernia repair. There was a corresponding decrease in the open surgical approach for all cases. Compared with laparoscopy, robotic surgery was associated with a significantly lower risk of conversion to open surgery: cholecystectomy, 1.7% vs 3.0% (odds ratio [OR], 0.55 [95% CI, 0.49-0.62]); colectomy, 11.2% vs 25.5% (OR, 0.37 [95% CI, 0.32-0.42]); inguinal hernia repair, 2.4% vs 10.7% (OR, 0.21 [95% CI, 0.16-0.26]); and ventral hernia repair, 3.5% vs 10.9% (OR, 0.30 [95% CI, 0.25-0.36]). Robotic surgery was associated with shorter postoperative lengths of stay for colectomy (-0.48 [95% CI, -0.60 to -0.35] days), inguinal hernia repair (-0.20 [95% CI, -0.30 to -0.10] days), and ventral hernia repair (-0.16 [95% CI, -0.26 to -0.06] days).ResultsDuring the study period, the use of robotic surgery increased significantly year-over-year for all procedures: 0.7% for cholecystectomy, 0.9% for colectomy, 1.9% for inguinal hernia repair, and 1.1% for ventral hernia repair. There was a corresponding decrease in the open surgical approach for all cases. Compared with laparoscopy, robotic surgery was associated with a significantly lower risk of conversion to open surgery: cholecystectomy, 1.7% vs 3.0% (odds ratio [OR], 0.55 [95% CI, 0.49-0.62]); colectomy, 11.2% vs 25.5% (OR, 0.37 [95% CI, 0.32-0.42]); inguinal hernia repair, 2.4% vs 10.7% (OR, 0.21 [95% CI, 0.16-0.26]); and ventral hernia repair, 3.5% vs 10.9% (OR, 0.30 [95% CI, 0.25-0.36]). Robotic surgery was associated with shorter postoperative lengths of stay for colectomy (-0.48 [95% CI, -0.60 to -0.35] days), inguinal hernia repair (-0.20 [95% CI, -0.30 to -0.10] days), and ventral hernia repair (-0.16 [95% CI, -0.26 to -0.06] days).While robotic surgery is still not broadly used for emergency general surgery, the findings of this study suggest it is becoming more prevalent and may be associated with better outcomes as measured by reduced conversion to open surgery and decreased length of stay.Conclusions and RelevanceWhile robotic surgery is still not broadly used for emergency general surgery, the findings of this study suggest it is becoming more prevalent and may be associated with better outcomes as measured by reduced conversion to open surgery and decreased length of stay.
Although robotic surgery has become an established approach for a wide range of elective operations, data on its utility and outcomes are limited in the setting of emergency general surgery. To describe temporal trends in the use of laparoscopic and robotic approaches and compare outcomes between robotic and laparoscopic surgery for 4 common emergent surgical procedures. A retrospective cohort study of an all-payer discharge database of 829 US facilities was conducted from calendar years 2013 to 2021. Data analysis was performed from July 2022 to November 2023. A total of 1 067 263 emergent or urgent cholecystectomies (n = 793 800), colectomies (n = 89 098), inguinal hernia repairs (n = 65 039), and ventral hernia repairs (n = 119 326) in patients aged 18 years or older were included. Surgical approach (robotic, laparoscopic, or open) to emergent or urgent cholecystectomy, colectomy, inguinal hernia repair, or ventral hernia repair. The primary outcome was the temporal trend in use of each operative approach (laparoscopic, robotic, or open). Secondary outcomes included conversion to open surgery and length of stay (both total and postoperative). Temporal trends were measured using linear regression. Propensity score matching was used to compare secondary outcomes between robotic and laparoscopic surgery groups. During the study period, the use of robotic surgery increased significantly year-over-year for all procedures: 0.7% for cholecystectomy, 0.9% for colectomy, 1.9% for inguinal hernia repair, and 1.1% for ventral hernia repair. There was a corresponding decrease in the open surgical approach for all cases. Compared with laparoscopy, robotic surgery was associated with a significantly lower risk of conversion to open surgery: cholecystectomy, 1.7% vs 3.0% (odds ratio [OR], 0.55 [95% CI, 0.49-0.62]); colectomy, 11.2% vs 25.5% (OR, 0.37 [95% CI, 0.32-0.42]); inguinal hernia repair, 2.4% vs 10.7% (OR, 0.21 [95% CI, 0.16-0.26]); and ventral hernia repair, 3.5% vs 10.9% (OR, 0.30 [95% CI, 0.25-0.36]). Robotic surgery was associated with shorter postoperative lengths of stay for colectomy (-0.48 [95% CI, -0.60 to -0.35] days), inguinal hernia repair (-0.20 [95% CI, -0.30 to -0.10] days), and ventral hernia repair (-0.16 [95% CI, -0.26 to -0.06] days). While robotic surgery is still not broadly used for emergency general surgery, the findings of this study suggest it is becoming more prevalent and may be associated with better outcomes as measured by reduced conversion to open surgery and decreased length of stay.
Author Abou-Zamzam, Aida
Florecki, Katherine L
Kent, Alistair J
Shih, I-Fan
Chidambaram, Swathikan
Sakran, Joseph V
Lunardi, Nicole
Joseph, Bellal
Byrne, James P
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  givenname: Nicole
  surname: Lunardi
  fullname: Lunardi, Nicole
  organization: Department of Surgery, University of Texas Southwestern, Dallas
– sequence: 2
  givenname: Aida
  surname: Abou-Zamzam
  fullname: Abou-Zamzam, Aida
  organization: Johns Hopkins University School of Medicine, Baltimore, Maryland
– sequence: 3
  givenname: Katherine L
  surname: Florecki
  fullname: Florecki, Katherine L
  organization: Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
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  givenname: Swathikan
  surname: Chidambaram
  fullname: Chidambaram, Swathikan
  organization: Department of Surgery and Cancer, Imperial College London, London, United Kingdom
– sequence: 5
  givenname: I-Fan
  surname: Shih
  fullname: Shih, I-Fan
  organization: Global Access Value Economics, Intuitive Surgical, Sunnyvale, California
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  givenname: Alistair J
  surname: Kent
  fullname: Kent, Alistair J
  organization: Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
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  givenname: Bellal
  surname: Joseph
  fullname: Joseph, Bellal
  organization: Department of Surgery, University of Arizona, Tucson
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  givenname: James P
  surname: Byrne
  fullname: Byrne, James P
  organization: Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
– sequence: 9
  givenname: Joseph V
  surname: Sakran
  fullname: Sakran, Joseph V
  organization: Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
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References 38446439 - JAMA Surg. 2024 May 1;159(5):500. doi: 10.1001/jamasurg.2024.0023.
38717510 - JAMA Surg. 2024 May 1;159(5):593. doi: 10.1001/jamasurg.2024.1326.
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StartPage 493
SubjectTerms Acute Care Surgery
Adult
Aged
Cholecystectomy - methods
Cholecystectomy - statistics & numerical data
Colectomy - methods
Conversion to Open Surgery - statistics & numerical data
Emergencies
Female
Hernia, Inguinal - surgery
Hernia, Ventral - surgery
Herniorrhaphy - methods
Humans
Laparoscopy
Length of Stay - statistics & numerical data
Male
Middle Aged
Minimally Invasive Surgical Procedures
Retrospective Studies
Robotic Surgical Procedures - statistics & numerical data
United States
Title Robotic Technology in Emergency General Surgery Cases in the Era of Minimally Invasive Surgery
URI https://www.ncbi.nlm.nih.gov/pubmed/38446451
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