Dhamija Anish, Dhamija Ankit, Hancock Jacquelyn, McCloskey Barbara, Kim Anthony W, Detterbeck Frank C, Boffa Daniel J
Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA.
Eur J Cardiothorac Surg. 2014 May;45(5):904-9. doi: 10.1093/ejcts/ezt482. Epub 2013 Oct 3.
The minimally invasive oesophagectomy (MIO) approach offers a number of advantages over open approaches including reduced discomfort, shorter length of stay and a faster recovery to baseline status. On the other hand, minimally invasive procedures typically are longer and consume greater disposable instrumentation, potentially resulting in a greater overall cost. The objective of this study was to compare costs associated with various oesophagectomy approaches for oesophageal cancer.
An institutional Resource Information Management System (RIMS) was queried for cost data relating to hospital expenditures (as opposed to billings or collections). The RIMS was searched for patients undergoing oesophagectomy for oesophageal cancer between 2003 and 2012 via minimally invasive, open transthoracic (OTT) (including Ivor Lewis, modified McKeown or thoracoabdominal) or transhiatal approaches. Patients that were converted from minimally invasive to open, or involved hybrid procedures, were excluded.
A total of 160 oesophagectomies were identified, including 61 minimally invasive, 35 open transthoracic and 64 transhiatal. Costs on the day of surgery averaged higher in the MIO group ($12 476 ± 2190) compared with the open groups, OTT ($8202 ± 2512, P < 0.0001) or OTH ($5809 ± 2575, P < 0.0001). The median costs associated with the entire hospitalization also appear to be higher in the MIO group ($25 935) compared with OTT ($24 440) and OTH ($15 248). The average length of stay was lowest in the MIO group (11 ± 9 days) compared with OTT (19 ± 18 days, P = 0.006) and OTH (18 ± 28 days P = 0.07). The operative mortality was similar in the three groups (MIO = 3%, OTT = 9% and OTH = 3%).
The operating theatre costs associated with minimally invasive oesophagectomy are significantly higher than OTT or OTH approaches. Unfortunately, a shorter hospital stay after MIO does not consistently offset higher surgical expense, as total hospital costs trend higher in the MIO patients. In an increasingly strained health care economy, efforts to reduce costs associated with the minimally invasive approach should address the inpatient hospitalization as well as operating theatre expenses.
与开放手术相比，微创食管切除术（MIO）具有诸多优势，包括不适程度减轻、住院时间缩短以及恢复至基线状态更快。另一方面，微创手术通常耗时更长，消耗更多一次性器械，这可能导致总体成本更高。本研究的目的是比较食管癌不同食管切除手术方式的成本。
查询机构资源信息管理系统（RIMS）以获取与医院支出（而非计费或收款）相关的成本数据。在RIMS中搜索2003年至2012年间接受食管癌食管切除术的患者，手术方式包括微创、开放经胸（OTT）（包括Ivor Lewis术、改良McKeown术或胸腹联合术）或经裂孔手术。排除从微创转为开放手术或涉及杂交手术的患者。
共识别出160例食管切除术，其中61例为微创，35例为开放经胸手术，64例为经裂孔手术。与开放手术组相比，MIO组手术当天的成本平均更高（12476美元±2190美元），OTT组为（8202美元±2512美元，P<0.0001），经裂孔手术组为（5809美元±2575美元，P<0.0001）。与整个住院期间相关的中位成本在MIO组（25935美元）似乎也高于OTT组（24440美元）和经裂孔手术组（15248美元）。MIO组的平均住院时间最短（11±9天），而OTT组为（19±18天，P = 0.006），经裂孔手术组为（18±28天，P = 0.07）。三组的手术死亡率相似（MIO = 3%，OTT = 9%，经裂孔手术组 = 3%）。
与微创食管切除术相关的手术室成本显著高于OTT或经裂孔手术方式。遗憾的是，MIO术后较短的住院时间并不能始终抵消较高的手术费用，因为MIO患者的总住院成本呈上升趋势。在日益紧张的医疗经济环境下，降低微创方法相关成本的努力应同时关注住院费用和手术室费用。
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