Rhou Yoon J J, Pather Selvan, Loadsman John A, Campbell Neil, Philp Shannon, Carter Jonathan
The Sydney Gynaecologic Oncology Group, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2015 Dec;55(6):584-7. doi: 10.1111/ajo.12093. Epub 2013 May 2.
To assess the direct intraoperative and postoperative costs in women undergoing total laparoscopic hysterectomy and fast-track open hysterectomy.
A retrospective review of the direct hospital-related costs in a matched cohort of women undergoing total laparoscopic hysterectomy (TLH) and fast-track open hysterectomy (FTOH) at a tertiary hospital. All costs were calculated, including the cost of advanced high-energy laparoscopic devices. The effect of the learning curve on cost in laparoscopic hysterectomy was also assessed, as was the hospital case-weighted cost, which was compared with the actual cost.
Fifty women were included in each arm of the study. TLH had a higher intraoperative cost, but a lower postoperative cost than FTOH (AUD$3877 vs AUD$2776 P < 0.001, AUD$3965 vs AUD$6233 P < 0.001). The total cost of TLH was not different from FTOH (AUD$7842 vs AUD$9009 P = 0.068) and after a learning curve; TLH cost less than FTOH (AUD$6797 vs AUD$8647, P < 0.001). The use of high-energy devices did not impact on the cost benefit of TLH, and hospital case-weight-based funding correlated poorly with actual cost.
Despite the use of fast-track recovery protocols, the cost of TLH is no different to FTOH and after a learning curve is cheaper than open hysterectomy. Judicious use of advanced energy devices does not impact on the cost, and hospital case-weight-based funding model in our hospital is inaccurate when compared to directly calculated hospital costs.
评估接受全腹腔镜子宫切除术和快速康复开放式子宫切除术的女性患者术中及术后的直接费用。
对一家三级医院中接受全腹腔镜子宫切除术（TLH）和快速康复开放式子宫切除术（FTOH）的匹配队列女性患者的直接医院相关费用进行回顾性分析。计算所有费用，包括先进的高能腹腔镜设备的费用。还评估了学习曲线对腹腔镜子宫切除术成本的影响，以及医院病例加权成本，并将其与实际成本进行比较。
研究的每组纳入50名女性。TLH的术中成本较高，但术后成本低于FTOH（分别为3877澳元对2776澳元，P < 0.001；3965澳元对6233澳元，P < 0.001）。TLH的总成本与FTOH无差异（7842澳元对9009澳元，P = 0.068），经过学习曲线后，TLH的成本低于FTOH（6797澳元对8647澳元，P < 0.001）。高能设备的使用并未影响TLH的成本效益，且基于医院病例加权的资金与实际成本相关性较差。
尽管采用了快速康复方案，但TLH的成本与FTOH并无差异，经过学习曲线后比开放式子宫切除术更便宜。明智地使用先进能量设备不会影响成本，并且与直接计算的医院成本相比，我院基于医院病例加权的资金模式不准确。
