Dowson Henry M, Huang Andy, Soon Yuen, Gage Heather, Lovell David P, Rockall Timothy A
Minimal Access Therapy Training Unit, Royal Surrey County Hospital, Guildford, Surrey, UK.
Dis Colon Rectum. 2007 Jun;50(6):908-19. doi: 10.1007/s10350-007-0234-5.
Recent studies have confirmed the clinical efficacy of laparoscopic colorectal surgery; however, its use has not become widespread. One reason for this is perceived economic implications. A systematic review was undertaken examining the costs of laparoscopic colorectal surgery.
Electronic databases were searched for articles comparing laparoscopic colorectal surgery and open surgery. Primary outcome measures were operating room, direct hospital, and indirect costs. Secondary outcomes were conversion rates and length of hospital stay. The percentage difference in costs was used for comparisons between studies.
Twenty-nine articles were identified in which cost data were presented (total number of patients 3,681); the economic data in most studies was limited. Operating room costs were greater for laparoscopic colorectal surgery than open surgery in all studies (median difference, 50 percent; interquartile range, 27-78 percent; P < 0.001). There was no overall difference in total hospital costs (median difference, 0 percent; interquartile range, -17.5 to 21 percent). Only two articles collected data on indirect costs, with both in favor of laparoscopic colorectal surgery. Hospital stay was shorter for laparoscopic colorectal surgery in all studies (median difference, 2.8 days; interquartile range, 1.3-3.7; P < 0.001). Median conversion rate was 7.8 percent (mean, 14 percent; interquartile range, 6-21 percent).
Operating room costs are greater for laparoscopic colorectal surgery than open surgery. Total hospital costs are similar. There may be societal benefits associated with lower indirect costs for laparoscopic colorectal surgery. Cost should not be a deterrent to performing laparoscopic colorectal surgery.
近期研究已证实腹腔镜结直肠手术的临床疗效；然而，其应用尚未广泛普及。原因之一是人们认为其存在经济影响。本研究进行了一项系统评价，以考察腹腔镜结直肠手术的成本。
检索电子数据库中比较腹腔镜结直肠手术与开放手术的文章。主要结局指标为手术室成本、直接住院成本和间接成本。次要结局为中转率和住院时间。研究间比较采用成本差异百分比。
共纳入29篇呈现成本数据的文章（患者总数3681例）；大多数研究的经济数据有限。所有研究中，腹腔镜结直肠手术的手术室成本均高于开放手术（中位数差异为50%；四分位间距为27% - 78%；P < 0.001）。总住院成本无总体差异（中位数差异为0%；四分位间距为 - 17.5%至21%）。仅两篇文章收集了间接成本数据，且均支持腹腔镜结直肠手术。所有研究中，腹腔镜结直肠手术的住院时间均较短（中位数差异为2.8天；四分位间距为1.3 - 3.7天；P < 0.001）。中转率中位数为7.8%（均值为14%；四分位间距为6% - 21%）。
腹腔镜结直肠手术的手术室成本高于开放手术。总住院成本相似。腹腔镜结直肠手术间接成本较低可能带来社会效益。成本不应成为开展腹腔镜结直肠手术的阻碍。
