Ozturk Ersin, Kiran Ravi P, Geisler Daniel P, Hull Tracy L, Vogel Jon D
Department of Colorectal Surgery, The Cleveland Clinic, Cleveland, OH 44195, USA.
J Am Coll Surg. 2009 Aug;209(2):242-7. doi: 10.1016/j.jamcollsurg.2009.03.024. Epub 2009 May 28.
Comparison studies of hand-assisted and laparoscopic-assisted colectomy have indicated that short-term outcomes are similar. Although a few of these studies have compared costs, none has reported on the costs of hand-assisted colectomy performed in the US. Our aim was to determine the short-term outcomes and direct costs associated with hand-assisted and laparoscopic-assisted colectomy performed in the US.
One hundred hand-assisted laparoscopic colectomies were matched to 100 laparoscopic-assisted colectomies performed concurrently. Matching criteria were age (+/- 10 years), gender, diagnosis, American Society of Anesthesiologists score, earlier abdominal operation, colectomy type, and conversion. Operative time, morbidity, length of stay, reoperation, and readmission were assessed. Direct costs for the operating room, nursing care, intensive care, anesthesia, laboratory, pharmacy, radiology, emergency services and consultations, and professional and ancillary services related to the initial hospitalization and readmissions were compared.
From June 2005 to August 2008, 176 hand-assisted and 845 laparoscopic-assisted segmental and total colectomies were performed. Of 100 matched hand-assisted and laparoscopic-assisted patients, there were no differences in body mass index (29 and 28, respectively), operating time (168 and 163 minutes, respectively), length of stay (4 days), readmission (6% and 11%, respectively), or reoperation rates (5% and 9%, respectively). Overall morbidity was 16% and 32% for hand-assisted and laparoscopic-assisted colectomy, respectively (p = 0.009). Major morbidity, including abscess, hemorrhage, and anastomotic leak, were similar. Operating room costs were increased for hand-assisted colectomy (3,476 versus 3,167 US dollars); total costs were similar (8,521 versus 8,373 US dollars).
Short-term outcomes and total costs of hand-assisted and laparoscopic-assisted colectomy are similar.
手辅助与腹腔镜辅助结肠切除术的比较研究表明，短期结果相似。尽管其中一些研究比较了成本，但没有一项报告美国手辅助结肠切除术的成本。我们的目的是确定美国手辅助与腹腔镜辅助结肠切除术的短期结果及直接成本。
100例手辅助腹腔镜结肠切除术与同期进行的100例腹腔镜辅助结肠切除术进行匹配。匹配标准为年龄（±10岁）、性别、诊断、美国麻醉医师协会评分、既往腹部手术史、结肠切除术类型及中转情况。评估手术时间、发病率、住院时间、再次手术及再次入院情况。比较手术室、护理、重症监护、麻醉、实验室、药房、放射科、急诊服务及会诊以及与初次住院和再次入院相关的专业及辅助服务的直接成本。
2005年6月至2008年8月，共进行了176例手辅助和845例腹腔镜辅助节段性及全结肠切除术。在100例匹配的手辅助和腹腔镜辅助患者中，体重指数（分别为29和28）、手术时间（分别为168分钟和163分钟）、住院时间（4天）、再次入院率（分别为6%和11%）或再次手术率（分别为5%和9%）无差异。手辅助和腹腔镜辅助结肠切除术的总体发病率分别为16%和32%（p = 0.009）。包括脓肿、出血和吻合口漏在内的主要发病率相似。手辅助结肠切除术的手术室成本增加（3476美元对3167美元）；总成本相似（8521美元对8373美元）。
手辅助与腹腔镜辅助结肠切除术的短期结果和总成本相似。
