Department of General Surgery, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL, 32224, USA,
Surg Endosc. 2013 Dec;27(12):4518-23. doi: 10.1007/s00464-013-3101-6. Epub 2013 Aug 13.
The laparoscopic approach to pancreaticoduodenectomy has been recently more frequently reported and is now being performed at multiple centers across the US. While laparoscopic pancreaticoduodenectomy (LPD) has been shown to be safe and feasible, comparing its cost in relation to open pancreaticoduodenectomy (OPD) has not been examined. The aim of this study is to examine the cost of LPD compared with OPD at a single institution over a 3-year time period.
An institutional database was analyzed to compare patients who underwent OPD and LPD (including Whipple resections and total pancreatectomy) between May 2009 and June 2012. A cost analysis was performed, which included the use the hospital billing database to assess surgical costs, hospital admission costs, and overall cost of the patient's care during the index admission. The operative costs were further analyzed with respect to OR time and surgical supplies. Standard statistical analysis was performed to assess for significance.
In the study time period, 123 patients underwent pancreaticoduodenectomy, including 48 OPD (39%) and 75 LPD (61%). The groups were similar with respect to age, gender, ASA, vein resection, and indication for surgery. In the LPD group, the use of hand assist or conversion to OPD occurred in 3 (4%) and 10 (13%) patients, respectively. Additionally, 10% of the OPD group underwent total pancreatectomy (n = 5), compared to 21% of the LPD (n = 16). Mean operative time for OPD and LPD was 355 min (range 199-681) and 551 min (range 390-819) respectively (p < 0.0001). Median hospital stay for OPD and LPD was 8 days (range 5-63), and 7 days (range 4-68) respectively (p = 0.5). Morbidity rates were equal at 31% for the two groups. The LPD group was associated with significantly higher surgical cost due to both increased time and supply cost. However, mean hospital admission cost associated with OPD was greater in comparison to the LPD group, though not significant. The overall total cost of care was similar between the two groups.
LPD is associated with equivalent overall cost compared with OPD. While operating time and supply costs were higher for LPD, this was balanced by decreased cost of the postoperative admission.
腹腔镜胰十二指肠切除术（LPD）近来报道较多，目前已在美国多个中心开展。虽然 LPD 已被证明是安全可行的，但尚未对其与开腹胰十二指肠切除术（OPD）的成本进行比较。本研究旨在比较单中心 3 年内 LPD 和 OPD 的成本。
分析了 2009 年 5 月至 2012 年 6 月接受 OPD 和 LPD（包括胰头十二指肠切除术和全胰切除术）的患者的机构数据库。进行了成本分析，包括使用医院计费数据库评估手术成本、住院费用以及患者在住院期间的总体治疗费用。进一步分析了手术时间和手术耗材对手术费用的影响。采用标准统计学分析方法评估其显著性。
在研究期间，123 例患者接受了胰十二指肠切除术，其中 48 例接受了 OPD（39%），75 例接受了 LPD（61%）。两组在年龄、性别、ASA、静脉切除和手术指征方面相似。在 LPD 组中，3 例（4%）和 10 例（13%）患者分别采用手助或中转 OPD。此外，OPD 组中有 10%（n=5）患者行全胰切除术，而 LPD 组中有 21%（n=16）。OPD 和 LPD 的平均手术时间分别为 355 分钟（范围 199-681）和 551 分钟（范围 390-819）（p<0.0001）。OPD 和 LPD 的中位住院时间分别为 8 天（范围 5-63）和 7 天（范围 4-68）（p=0.5）。两组的并发症发生率相同，均为 31%。由于手术时间和耗材成本增加，LPD 组的手术费用明显较高。然而，与 LPD 组相比，OPD 组的平均住院费用较高，但无统计学意义。两组的总治疗费用相似。
LPD 的总费用与 OPD 相当。虽然 LPD 的手术时间和耗材成本较高，但通过降低术后住院费用得到了平衡。
