Thompson Bridie S, Coory Michael D, Gordon Louisa G, Lumley John W
School of Population Health, The University of Queensland, Level 2, Public Health Building, Herston, QLD, Australia,
Surg Endosc. 2014 May;28(5):1515-21. doi: 10.1007/s00464-013-3345-1. Epub 2013 Dec 14.
Previous cost analyses of laparoscopic resection for colorectal cancer (CRC) reported slightly higher or similar costs to those of open resection. These analyses were based on randomised controlled trials when the laparoscopic approach was newly adopted. This study compared costs for laparoscopic versus open resection in a region of high uptake where adoption is mature.
Hospital cost data were obtained for elective resections for CRC that occurred between June 2009 and June 2011 in public hospitals in Queensland, Australia. The primary outcome was total cost and secondary outcomes were length-of-stay, operating time, and ICU admission. Multivariate least-squares regression was used to adjust for potential confounders: age, sex, comorbidities, procedure, and hospital volume.
The crude mean cost for laparoscopic resection was euro 20,036 compared with that for open resection of euro 22,780 (difference = euro 2,744). Patients who underwent laparoscopic resection (744/1,397; 53 %) were slightly younger and had fewer comorbidities (decreasing costs) but more had rectal surgery (increasing costs). The adjusted mean cost for laparoscopic resection was euro 20,396 compared with euro 22,442 for open resection (difference = euro 2,054). Compared with open resection, when adjusted for potential confounders, laparoscopic resection resulted in similar operating time (216 vs. 214 min), shorter length-of-stay (difference = -1.1 days, 95 % CI -1.9, -0.3), and shorter admission to ICU (difference = -7.3 h, 95 % CI -11.9, -2.7).
This non-randomised study in a region of high uptake found a similar operating time and lower cost for laparoscopic resection for CRC compared with those of open resection due to a shorter length-of-stay and shorter time in ICU. Laparoscopic resection for CRC saves money when the procedure is widely adopted and surgeons are experienced in the technique.
先前关于结直肠癌（CRC）腹腔镜切除术的成本分析报告称，其成本略高于或与开放切除术相似。这些分析基于腹腔镜手术新采用时的随机对照试验。本研究比较了在腹腔镜手术采用率高且成熟的地区，腹腔镜切除术与开放切除术的成本。
获取了2009年6月至2011年6月期间澳大利亚昆士兰州公立医院进行的CRC择期切除术的医院成本数据。主要结局是总成本，次要结局是住院时间、手术时间和重症监护病房（ICU）入住情况。采用多变量最小二乘回归对潜在混杂因素进行调整：年龄、性别、合并症、手术方式和医院规模。
腹腔镜切除术的粗略平均成本为20,036欧元，而开放切除术为22,780欧元（差值 =
2,744欧元）。接受腹腔镜切除术的患者（744/1,397；53%）年龄稍小，合并症较少（成本降低），但接受直肠手术的患者较多（成本增加）。腹腔镜切除术的调整后平均成本为20,396欧元，而开放切除术为22,442欧元（差值 =
2,054欧元）。与开放切除术相比，在对潜在混杂因素进行调整后，腹腔镜切除术的手术时间相似（216对214分钟），住院时间更短（差值 = -1.1天，95%可信区间 -1.9，-0.3），ICU入住时间更短（差值 = -7.3小时，95%可信区间 -11.9，-2.7）。
在腹腔镜手术采用率高的地区进行的这项非随机研究发现，与开放切除术相比，CRC腹腔镜切除术的手术时间相似，但成本较低，原因是住院时间更短和ICU停留时间更短。当该手术被广泛采用且外科医生对该技术有经验时，CRC腹腔镜切除术可节省费用。
