Canadian Surgical Technologies and Advance Robotics, London Health Science Centre, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, 339 Windermere Road, PO Box 5339, London, ON N6A 5A5, Canada.
Surg Endosc. 2011 Nov;25(11):3597-604. doi: 10.1007/s00464-011-1765-3. Epub 2011 Jun 8.
Real-world cost analysis of elective laparoscopic versus open colon resection in a tertiary Canadian teaching hospital was performed to evaluate the financial impact of minimally invasive surgery with the appointment of an experienced laparoscopic surgeon in a single-payer system.
A retrospective review of elective laparoscopic and open segmental colectomies (2005-2010) was performed. Combined cases and procedures performed for inpatients were excluded to minimize cost variation. The hospital case-costing system was used to calculate the hourly cost of operating room time and the daily hospital ward stay. The cost of disposable equipment was calculated manually. A cost-minimization analysis was performed from the hospital perspective, which excludes physician payment. Cases were analyzed on an intention-to-treat basis.
For this study, 470 right-side colectomies (322 open and 148 laparoscopic) and 266 left-side colectomies (181 open and 85 laparoscopic) were found to match the inclusion criteria. The operating room time was longer for the laparoscopic procedures than for the open procedures: 203.4 versus 173.4 min (P = 0.1) for right and extended right hemicolectomy (RC) and 287.4 versus 173.4 min (P = 0.009) for left and sigmoid colectomy (LC). This resulted in higher operating room costs: $4,094.10 versus $3312.11 for RC and $5,784.88 versus $4,582.55 for LC. The median hospital stay for an index admission was shorter for both sides: 5 days versus 8 days (P = 0.01) for RC and 4 days versus 6 days (P = 0.04). This resulted in lower ward costs: $4,556.07 versus $6,632.82 for RC and $3,297.24 versus $5,949.09 for LC. The cost of care per index admission after laparoscopic versus open resection was $10,097.93 versus $10,444.69 for RC and $11,067.72 versus. $11,146.56 for LC. The introduction of laparoscopic surgery has saved our institution $58,021.43 over 5 years.
The reasons for observed differences in operating room time and length of hospital stay were uncontrolled and may be multifactorial. However, the results demonstrate that adopting a laparoscopic approach for elective colon surgery resulted in progressive financial savings.
在一家加拿大的三级教学医院进行了择期腹腔镜与开腹结肠切除术的真实成本分析，以评估在单一支付者系统下，由经验丰富的腹腔镜外科医生进行微创手术的财务影响。
对 2005 年至 2010 年的择期腹腔镜和开腹结肠切除术（RC 和 LC）进行了回顾性分析。排除联合病例和住院患者的手术，以尽量减少成本差异。使用医院病例成本核算系统计算手术室时间和每日住院病房费用。手动计算一次性设备的成本。从医院角度进行了成本最小化分析，不包括医生薪酬。病例采用意向治疗进行分析。
在这项研究中，符合纳入标准的有 470 例右半结肠切除术（322 例开腹手术和 148 例腹腔镜手术）和 266 例左半结肠切除术（181 例开腹手术和 85 例腹腔镜手术）。腹腔镜手术的手术室时间长于开腹手术：右半结肠切除术（RC）和扩展右半结肠切除术（RC）的手术时间分别为 203.4 分钟和 173.4 分钟（P=0.1），左半结肠切除术（LC）和乙状结肠切除术（LC）的手术时间分别为 287.4 分钟和 173.4 分钟（P=0.009）。这导致手术费用增加：RC 为 4094.10 美元，1734.11 美元；LC 为 5784.88 美元，4582.55 美元。双侧初次入院的中位住院时间均缩短：RC 为 5 天和 8 天（P=0.01），LC 为 4 天和 6 天（P=0.04）。这导致病房费用降低：RC 为 4556.07 美元，6632.82 美元；LC 为 3297.24 美元，5949.09 美元。腹腔镜与开腹切除术后每次住院的治疗费用分别为 RC 为 10097.93 美元，10444.69 美元；LC 为 11067.72 美元，11146.56 美元。5 年来，腹腔镜手术的引入为我们机构节省了 58021.43 美元。
观察到的手术室时间和住院时间差异的原因是无法控制的，可能是多因素的。然而，结果表明，采用腹腔镜手术治疗择期结肠手术可带来持续的财务节约。
