Noblett S E, Horgan A F
Department of Surgery, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, United Kingdom.
Surg Endosc. 2007 Mar;21(3):404-8. doi: 10.1007/s00464-006-9016-8. Epub 2006 Dec 16.
We aimed to assess the clinical outcomes and costs associated with laparoscopic resection within an elective colorectal practice.
Over a 12-month period data were prospectively collected on patients undergoing elective colorectal resection under the care of a single consultant surgeon. Thirty patients undergoing laparoscopic colorectal resection were case-matched by type of resection, disease process, and, where appropriate, cancer stage to patients having open surgery. A cost analysis was carried out incorporating cost of surgical bed stay, theater time, and specific equipment costs.
In the 30 patients having laparoscopic resection, a conversion rate of 13% was observed. Surgery was performed for colorectal cancer in 83% of patients, and 53% of resections were rectal. No significant differences were found in age (65 versus 69 years, p = 0.415), BMI (27.4 versus 26.1, p = 0.527), POSSUM physiology score (16 versus 16.5, p = 0.102), American Society of Anesthesiologists (ASA) grade (2 versus 2, p = 0.171), or length of theater time (160 min versus 160 min, p = 0.233) between the laparoscopic and open patients. Hospital stay was reduced in the laparoscopic group (5 versus 9 days, p < 0.001). Average cost of surgical equipment used for a laparoscopic resection was greater than for open surgery (912.39 versus 276.41 pounds, p = 0.001). Cost of hospital stay was significantly less (1259.75 versus 2267.55 pounds, p < 0.001). Cost of operating room time was similar for the two groups (2066.63 versus 1945.07 pounds, p = 0.152). Overall no significant cost difference could be found between open and laparoscopic resection (4560.9 versus 4348.45 pounds, p = 0.976). More postoperative complications were seen in the open resection group (14 versus 4, p < 0.001).
Intraoperative equipment costs are greater for laparoscopic resection than for open surgery. However, benefits can be seen in terms of quicker recovery and shorter hospital stay. Laparoscopic surgery is a financially viable alternative to open resection in selected patients.
我们旨在评估在择期结直肠手术中腹腔镜切除术的临床疗效及成本。
在12个月期间，前瞻性收集了由一名顾问外科医生负责的接受择期结直肠切除术患者的数据。30例行腹腔镜结直肠切除术的患者，按照切除类型、疾病进程以及在合适情况下按照癌症分期与接受开放手术的患者进行病例匹配。进行了成本分析，纳入了手术床位住院费用、手术时间以及特定设备成本。
在30例行腹腔镜切除术的患者中，观察到13%的中转率。83%的患者因结直肠癌接受手术，53%的切除为直肠切除。腹腔镜组和开放手术组在年龄（65岁对69岁，p = 0.415）、体重指数（27.4对26.1，p = 0.527）、POSSUM生理评分（16对16.5，p = 0.102）、美国麻醉医师协会（ASA）分级（2级对2级，p = 0.171）或手术时间长度（160分钟对160分钟，p = 0.233）方面均未发现显著差异。腹腔镜组的住院时间缩短（5天对9天，p < 0.001）。腹腔镜切除术所用手术设备的平均成本高于开放手术（912.39英镑对276.41英镑，p = 0.001）。住院费用显著更低（1259.75英镑对2267.55英镑，p < 0.001）。两组的手术室时间成本相似（2066.63英镑对1945.07英镑，p = 0.152）。总体而言，开放手术和腹腔镜切除术之间未发现显著的成本差异（4560.9英镑对4348.45英镑，p = 0.976）。开放手术组术后并发症更多（14例对4例，p < 0.001）。
腹腔镜切除术的术中设备成本高于开放手术。然而，在更快恢复和更短住院时间方面可以看到益处。对于部分患者，腹腔镜手术在经济上是开放切除术可行的替代方案。
