Robotic-assisted cholecystectomy (RAC) is becoming increasingly common, but the outcomes of emergent/urgent robotic-assisted cholecystectomies compared to emergent laparoscopic (LC) and open cholecystectomies (OC) remain understudied. The PINC AI Healthcare Database was queried to identify adults who underwent emergent or urgent (Em-Ur) cholecystectomy between January 1, 2017, and December 31, 2020. Immediate postoperative and 30-day outcomes were identified including intraoperative complications, transfusion, conversion, postoperative complication, and hospital length of stay. Propensity score matching was done to compare outcomes between Em-Ur robotic-assisted, laparoscopic, and open cholecystectomies Subgroup analyses were performed comparing RAC done with and without fluorescent imaging as well as comparing RAC and LC performed for patients with class 3 obesity (BMI ≥ 40 kg/m2). RAC Em-Ur cholecystectomies are being performed with increasing frequency and is the most utilized modality for patients with class 3 obesity. There was no difference in intraoperative complications (0.3%), bile duct injury (0.2%), or postoperative outcomes between RAC and LC. LC had significantly shorter operating room times (96 min (75,128)) compared to RAC (120 min (90,150)). There was a significant lower rate of conversion to open in RAC (1.9%) relative to LC (3.2%) in both the overall population and the class 3 obesity sub-analysis (RAC-2.6% vs. LC-4.4%). There was no difference in outcomes in robotic-assisted cholecystectomies done with and without fluorescent imaging. A comparison of propensity score-matched cohorts of emergent/urgent robotic-assisted and laparoscopic cholecystectomy indicates that robotic-assisted cholecystectomy is a safe alternative to laparoscopic cholecystectomy, and that both have superior outcomes to open cholecystectomies.

中文翻译：

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基于 2017-2020 年 PINC AI 医疗保健数据库的腹腔镜、机器人辅助和开腹急诊/紧急胆囊切除术的回顾性研究


机器人辅助胆囊切除术 (RAC) 变得越来越普遍，但与紧急腹腔镜 (LC) 和开腹胆囊切除术 (OC) 相比，紧急/紧急机器人辅助胆囊切除术的结果仍有待研究。查询 PINC AI 医疗保健数据库以确定在 2017 年 1 月 1 日至 2020 年 12 月 31 日期间接受紧急或紧急 (Em-Ur) 胆囊切除术的成人。确定了术后即刻和 30 天的结果，包括术中并发症、输血、转院、术后并发症和住院时间。进行倾向评分匹配以比较 Em-Ur 机器人辅助、腹腔镜和开腹胆囊切除术之间的结果。进行亚组分析，比较使用和不使用荧光成像进行的 RAC，以及比较对 3 级肥胖患者进行的 RAC 和 LC（BMI ≥ 40公斤/平方米）。 RAC Em-Ur 胆囊切除术的实施频率越来越高，是 3 级肥胖患者最常用的治疗方式。 RAC 和 LC 之间的术中并发症（0.3%）、胆管损伤（0.2%）或术后结果没有差异。与 RAC（120 分钟（90,150））相比，LC 的手术时间显着缩短（96 分钟（75,128））。在总体人群和 3 级肥胖子分析中，RAC 的开放转化率 (1.9%) 相对于 LC (3.2%) 显着较低（RAC-2.6% 与 LC-4.4%）。使用和不使用荧光成像进行的机器人辅助胆囊切除术的结果没有差异。 对急诊/紧急机器人辅助和腹腔镜胆囊切除术的倾向评分匹配队列进行比较表明，机器人辅助胆囊切除术是腹腔镜胆囊切除术的安全替代方案，并且两者均具有优于开腹胆囊切除术的结果。