Mano Roy, Schulman Ariel, Hakimi A Ari, Sternberg Itay A, Bernstein Melanie, Bochner Bernard H, Coleman Jonathan A, Russo Paul
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Urology. 2015 Mar;85(3):596-603. doi: 10.1016/j.urology.2014.10.044. Epub 2015 Jan 10.
To compare immediate perioperative direct costs of open partial nephrectomy (OPN) and robotic partial nephrectomy (RPN), managed under a common care pathway.
Retrospective review of detailed institutional cost data for patients treated with OPN and RPN during 2011 was conducted. Cost and clinical data of OPN and RPN were compared for all patients and for patients stratified by length of stay (LOS), American Society of Anesthesiologists (ASA), and RENAL nephrometry scores.
The study cohort included 190 OPN and 63 RPN cases. OPN was associated with higher ASA scores (P <.001), shorter operative times (P = .014), and higher estimated blood loss (P <.001). Median (interquartile range) LOS was 2 days (2-3 days) for OPN compared with 1 day (1-2 days) for RPN (P <.001). Median perioperative cost of OPN was lower than that of RPN with a difference of $3091 (P <.001). Although hospitalization costs were higher in OPN, surgical costs were higher in RPN ($854 and $3695 difference in median costs, respectively; P <.001 for both). The total cost of OPN for patients with an above-average LOS remained lower than that of RPN ($2680 difference in median costs; P = .001). RPN costs remained significantly higher when stratifying patients by their ASA and RENAL nephrometry scores.
Despite the shorter hospital LOS associated with RPN, the immediate perioperative cost of OPN was lower than that of RPN for patients managed under a common care pathway, mainly due to high robotic purchase and maintenance costs. In light of the current health care debate, such financial disincentives may compromise the sustainability of advances in medical technology.
比较在共同护理路径管理下，开放性部分肾切除术（OPN）和机器人辅助部分肾切除术（RPN）围手术期的直接成本。
对2011年接受OPN和RPN治疗的患者的详细机构成本数据进行回顾性分析。比较了所有患者以及按住院时间（LOS）、美国麻醉医师协会（ASA）分级和RENAL肾计量评分分层的患者的OPN和RPN的成本及临床数据。
研究队列包括190例OPN病例和63例RPN病例。OPN与较高的ASA评分相关（P <.001），手术时间较短（P =.014），估计失血量较高（P <.001）。OPN的中位（四分位间距）住院时间为2天（2 - 3天），而RPN为1天（1 - 2天）（P <.001）。OPN的围手术期成本中位数低于RPN，相差3091美元（P <.001）。虽然OPN的住院成本较高，但RPN的手术成本较高（中位数成本分别相差854美元和3695美元；两者P均<.001）。住院时间高于平均水平的患者，OPN的总成本仍低于RPN（中位数成本相差2680美元；P =.001）。按患者的ASA和RENAL肾计量评分分层时，RPN的成本仍然显著较高。
尽管RPN相关的住院时间较短，但在共同护理路径管理下的患者，OPN围手术期的直接成本低于RPN，主要是由于机器人的购置和维护成本较高。鉴于当前的医疗保健争论，这种经济上的不利因素可能会影响医疗技术进步的可持续性。
