Department of Surgery, University of Manitoba, Winnipeg, MB, Canada,
Surg Endosc. 2014 Apr;28(4):1213-22. doi: 10.1007/s00464-013-3311-y. Epub 2013 Nov 21.
The objective of this study was to compare the total hospital cost of laparoscopic (lap) and open colon surgery at a publicly funded academic institution.
Patients undergoing elective laparoscopic or open colon surgery for all indications at the University Health Network, Toronto, Canada, from April 2004 to March 2009 were included. Patient demographic, operative, and outcome data were reviewed retrospectively. Hospital costs were determined from the Ontario Case Costing Initiative, adjusted for inflation, and compared using the Mann-Whitney U test. Linear regression was used to analyze the relationship between length of stay and total hospital cost.
There were 391 elective colon resections (223 lap/168 open, 15.4 % conversion). There was no difference in median age, gender, or Charlson score. Body mass index was slightly higher for laparoscopic surgery (27.5/25.9 lap/open; p = 0.008), while the American Society of Anesthesiologists score was slightly higher for open surgery. Median operative time was greater for laparoscopic surgery (224/196 min, lap/open; p = 0.001). There was no difference in complication rates (21.6/22.5 % lap/open; p = 0.900), reoperations (5.8/6.5 % lap/open; p = 0.833) or 30-day readmissions (7.6/12.5 % lap/open; p = 0.122). Number of emergency room visits was greater with open surgery (12.6/20.8 % lap/open; p = 0.037). Operative cost was higher for laparoscopic surgery ($4,171.37/3,489.29 lap/open; p = 0.001), while total hospital cost was significantly reduced ($9,600.22/12,721.41 lap/open; p = 0.001). Median length of stay was shorter for laparoscopic surgery (5/7 days lap/open; p = 0.000), and this correlated directly with hospital cost.
Laparoscopic colon surgery is associated with increased operative costs but significantly lower total hospital costs. The cost savings is related, in part, to reduced length of stay with laparoscopic surgery.
本研究旨在比较在一家公立学术机构中腹腔镜（lap）和开腹结肠手术的总住院费用。
纳入 2004 年 4 月至 2009 年 3 月在加拿大多伦多大学健康网络（University Health Network）接受所有适应证的择期腹腔镜或开腹结肠手术的患者。回顾性审查患者的人口统计学、手术和结局数据。从安大略病例成本核算倡议（Ontario Case Costing Initiative）确定住院费用，按通胀进行调整，并使用曼-惠特尼 U 检验进行比较。使用线性回归分析住院时间与总住院费用之间的关系。
共 391 例择期结肠切除术（223 例 lap/168 例 open，15.4%的中转率）。腹腔镜组和开腹组的中位年龄、性别或 Charlson 评分无差异。腹腔镜组的 BMI 略高（27.5/25.9 lap/open；p=0.008），而开腹组的美国麻醉医师协会（American Society of Anesthesiologists）评分略高。腹腔镜组的手术时间中位数较长（224/196 min，lap/open；p=0.001）。两组并发症发生率（21.6/22.5% lap/open；p=0.900）、再次手术率（5.8/6.5% lap/open；p=0.833）或 30 天内再入院率（7.6/12.5% lap/open；p=0.122）无差异。开腹组急诊就诊次数较多（12.6/20.8% lap/open；p=0.037）。腹腔镜组的手术费用较高（$4171.37/3489.29 lap/open；p=0.001），而总住院费用显著降低（$9600.22/12721.41 lap/open；p=0.001）。腹腔镜组的中位住院时间较短（5/7 天 lap/open；p=0.000），且与住院费用直接相关。
腹腔镜结肠手术与手术费用增加相关，但总住院费用显著降低。节省的成本部分与腹腔镜手术的住院时间缩短有关。
