Casali Gianluca, Walker William S
Cardiothoracic Surgery Department, Royal Infirmary of Edinburgh, Edinburgh, UK.
Eur J Cardiothorac Surg. 2009 Mar;35(3):423-8. doi: 10.1016/j.ejcts.2008.11.008. Epub 2009 Jan 10.
Although video-assisted thoracoscopic (VATS) lobectomy offers advantages with regard to pain, respiratory function and mobility, concern is often expressed concerning the cost of stapling devices and increased operative time. We have therefore compared the costs of VATS and open lobectomy in order to assess the overall economic sustainability of a VATS programme.
Between January 2004 and December 2006 346 patients underwent pulmonary lobectomy mainly for stage I or II lung cancer (93 VATS lobectomy, 253 thoracotomy). In the VATS group 47% of patients had an upper lobectomy versus 52% in the open group (p=ns). Direct medical costs (disposables, theatre time, high dependency unit stay, hospital stay) were determined and stratified by lobectomy type.
Mean theatre cost for a VATS lobectomy was 2533+/-230 euro versus 1280+/-54 euro for a thoracotomy lobectomy (p=0.00001). Mean high dependency unit (HDU) cost was 1713+/-236 euro and 2571+/-80 euro for a VATS and a thoracotomy lobectomy, respectively (p=0.00001). Mean cost of hospital stay for a VATS lobectomy was 3776+/-281 euro versus 4325+/-154 euro for an open one (p=0.00001). The overall cost for a VATS lobectomy was 8023+/-565 euro which was less than an open lobectomy 8178+/-167 euro (p=0.0002). VATS bilobectomy was slightly more expensive than an open one: 8702+/-350 euro versus 8655+/-466 euro but this difference (47 euro) was not significant (p=ns).
VATS lobectomy is less expensive than conventional lobectomy. Increased theatre costs (disposables and time) are counteracted by shorter hospital stay. Importantly, the reduced HDU and ward bed stays free resources for other patients.
尽管电视辅助胸腔镜（VATS）肺叶切除术在疼痛、呼吸功能和活动能力方面具有优势，但人们常常对缝合器械的成本和手术时间增加表示担忧。因此，我们比较了VATS和开胸肺叶切除术的成本，以评估VATS手术方案的整体经济可持续性。
2004年1月至2006年12月期间，346例患者接受了肺叶切除术，主要用于治疗I期或II期肺癌（93例VATS肺叶切除术，253例开胸手术）。在VATS组中，47%的患者接受了上叶切除术，而开胸组为52%（p=无统计学意义）。确定了直接医疗成本（一次性用品、手术时间、重症监护病房停留时间、住院时间），并按肺叶切除术类型进行分层。
VATS肺叶切除术的平均手术成本为2533±230欧元，而开胸肺叶切除术为1280±54欧元（p=0.00001）。VATS和开胸肺叶切除术的平均重症监护病房（HDU）成本分别为1713±236欧元和2571±80欧元（p=0.00001）。VATS肺叶切除术的平均住院成本为3776±281欧元，而开胸手术为4325±154欧元（p=0.00001）。VATS肺叶切除术的总成本为8023±565欧元，低于开胸肺叶切除术的8178±167欧元（p=0.0002）。VATS双叶切除术比开胸手术略贵：8702±350欧元对8655±466欧元，但这种差异（47欧元）不显著（p=无统计学意义）。
VATS肺叶切除术比传统肺叶切除术成本更低。手术成本增加（一次性用品和时间）被缩短的住院时间所抵消。重要的是，HDU和病房停留时间的减少为其他患者释放了资源。
