Salloum Rabih M, Bulter Debra C, Schwartz Seymour I
Department of Surgery, University of Rochester, Strong Memorial Hospital, Rochester, NY 14642, USA.
J Am Coll Surg. 2006 Feb;202(2):269-74. doi: 10.1016/j.jamcollsurg.2005.10.002. Epub 2005 Dec 19.
We performed a cost-benefit analysis of minimally invasive colectomy (MIC) with the appreciation that this approach extends the duration of the operation and requires additional instruments and equipment when compared with the open procedure. These negatives may be offset by decreased pain, earlier initiation of oral feeding, and a shorter hospitalization.
We reviewed operating room records of all open colectomies (OCs) and MICs performed at Strong Memorial Hospital between January 1, 2000, and March 31, 2004, as defined by CPT codes. Operating room times, total operating room costs, lengths of hospital stay, and total hospital costs were calculated for each procedure.
Sixty-eight right hemicolectomies (54 OCs and 14 MICs) were performed. Operating room time was significantly longer for MIC compared with OC (214 +/- 41 minutes versus 170 +/- 56 minutes, p = 0.01). Length of hospital stay was shorter for MIC compared with OC (4.5 +/- 1.3 days versus 7.4 +/- 2.5 days, p = 0.004). There were 131 left hemicolectomies (104 OCs and 27 MICs) performed. Operating room time was significantly longer for left MIC compared with left OC (256 +/- 46 minutes versus 213 +/- 60 minutes, p = 0.005). Length of hospital stay was shorter for left MIC than for left OC (4.4 +/- 1.3 days versus 7.9 +/- 3.0 days, p = 0.001). Total hospital costs were significantly lower for MIC compared with OC (8,580 US dollars +/- 1,358 US dollars versus 10,303 US dollars +/- 3,299 US dollars, p = 0.046).
MIC is associated with a significantly longer operating room time and a shorter hospital stay than OC. Operating room cost is significantly higher for MIC, but total hospital cost is lower. MIC is cost effective and results in significant savings to the health-care system.
我们对微创结肠切除术（MIC）进行了成本效益分析，认识到与开放手术相比，这种方法延长了手术时间，并且需要额外的器械和设备。这些不利因素可能会被疼痛减轻、更早开始经口进食以及缩短住院时间所抵消。
我们回顾了2000年1月1日至2004年3月31日期间在斯特朗纪念医院进行的所有开放结肠切除术（OC）和MIC的手术室记录，这些记录由CPT编码定义。计算了每个手术的手术室时间、手术室总费用、住院时间和医院总费用。
共进行了68例右半结肠切除术（54例OC和14例MIC）。与OC相比，MIC的手术室时间明显更长（214±41分钟对170±56分钟，p = 0.01）。与OC相比，MIC的住院时间更短（4.5±1.3天对7.4±2.5天，p = 0.004）。共进行了131例左半结肠切除术（104例OC和27例MIC）。与左OC相比，左MIC的手术室时间明显更长（256±46分钟对213±60分钟，p = 0.005）。左MIC的住院时间比左OC短（4.4±1.3天对7.9±3.0天，p = 0.001）。与OC相比，MIC的医院总费用明显更低（8580美元±1358美元对10303美元±3299美元，p = 0.046）。
与OC相比，MIC的手术室时间明显更长，但住院时间更短。MIC的手术室成本明显更高，但医院总费用更低。MIC具有成本效益，可为医疗保健系统带来显著节省。
