Department of Colorectal Surgery, Cleveland Clinic Foundation, Digestive Disease Institute-A30, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Surg Endosc. 2010 Nov;24(11):2718-22. doi: 10.1007/s00464-010-1032-z. Epub 2010 Apr 8.
This study aimed to investigate whether the learning curve during laparoscopic colectomy is associated with increased costs compared with the procedure after the learning curve has been achieved.
The direct costs for patients undergoing laparoscopic colectomy during the learning curve (group A) and after the attainment of proficiency by two colorectal surgeons performing the procedure (group B) between 2001 and 2007 were compared. The learning curve was defined as the first 40 laparoscopic colectomy cases for each surgeon. The distribution of cases for the surgeons ensured that cost-related differences were not influenced by lead time bias of cases performed during the learning curve.
The study involved 80 group A and 74 group B patients. Groups A and B were similar in terms of age (P = 0.7), gender (P = 0.5), American Society of Anesthesiologists (ASA) score (P = 0.5), body mass index (P = 0.3), diagnosis (P = 0.8), previous abdominal surgery (P = 0.07), and comorbidity (P = 0.4). The two groups also were similar with regard to performance of anastomosis (P = 0.2) or resection (P = 0.6), conversion to open surgery (P = 0.7), postoperative morbidity (P = 0.6), readmission (P = 0.1), reoperation rate (P = 0.6), and hospital length of stay (P = 0.6). The operation time was significantly longer for group A (P = 0.01). The total direct costs (P = 0.7) and the operating room (P = 0.6), nursing (P = 0.7), pharmacy (P = 0.9), radiology (P = 1), and professional (P = 0.051) costs were however similar between the two groups.
As expected, laparoscopic colectomy during the learning curve period is associated with prolonged operating time. Concerns pertaining to increased conversions, complications, and direct costs during this period were not substantiated in this study.
本研究旨在探讨腹腔镜结肠切除术的学习曲线是否与达到熟练程度后的手术相比，增加了成本。
比较了 2001 年至 2007 年间两位进行该手术的结直肠外科医生在学习曲线期间（A 组）和达到熟练程度后（B 组）接受腹腔镜结肠切除术的患者的直接成本。学习曲线定义为每位外科医生的前 40 例腹腔镜结肠切除术。两位外科医生的病例分布确保了成本相关差异不受学习曲线期间进行的病例的领先时间偏差的影响。
本研究共纳入 80 例 A 组和 74 例 B 组患者。A 组和 B 组在年龄（P = 0.7）、性别（P = 0.5）、美国麻醉医师协会（ASA）评分（P = 0.5）、体重指数（P = 0.3）、诊断（P = 0.8）、既往腹部手术史（P = 0.07）和合并症（P = 0.4）方面无差异。两组在吻合（P = 0.2）或切除（P = 0.6）、转为开放手术（P = 0.7）、术后发病率（P = 0.6）、再入院率（P = 0.1）、再手术率（P = 0.6）和住院时间（P = 0.6）方面也无差异。A 组的手术时间明显较长（P = 0.01）。两组的总直接成本（P = 0.7）、手术室（P = 0.6）、护理（P = 0.7）、药房（P = 0.9）、放射科（P = 1）和专业（P = 0.051）费用无差异。
正如预期的那样，学习曲线期间的腹腔镜结肠切除术与手术时间延长有关。本研究并未证实这一时期转换率、并发症和直接成本增加的问题。
