Canale Leonardo Secchin, Colafranceschi Alexandre Siciliano
Department of Cardiac Surgery, Pro Cardiaco Hospital, Rio de Janeiro, Brazil
Department of Cardiac Surgery, Pro Cardiaco Hospital, Rio de Janeiro, Brazil.
Interact Cardiovasc Thorac Surg. 2015 Jun;20(6):844-7. doi: 10.1093/icvts/ivv038. Epub 2015 Mar 10.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is robotic mitral valve surgery more expensive than its conventional counterpart?' Altogether 19 papers were found using the reported search, of which 5 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There is a general impression in the surgical community that robotic operations might incur prohibitive additional costs. There is a paucity of data in the literature regarding cost analysis in cardiac robotic surgery. From the five studies, four were single institution experiences and one was a database inquiry study. These four studies showed that operational costs are higher for robotic cases but this was partially (one study) or completely (three studies) offset by lower postoperative costs. Overall hospital costs were similar between the two approaches in three studies and one study showed higher costs in the robotic group. Higher operating theatre (OT) costs were driven mainly by use of robotic instruments (approximately US$1500 per case) and longer OT times. Savings in postoperative care were driven by shorter length of hospital stay (on average 2 days fewer in robotic cases) and lower morbidity. If amortization cost, that is, the value of the initial capital investment on the robotic system divided by all operations performed, is included in this analysis, robotic approach becomes significantly more expensive by approximately US$3400 per case. The fifth study was a large national database inquiry in which robotic approach was found to be more expensive by US$600 per case excluding amortization cost and by US$3700 if amortization is included. We conclude that the total hospital cost of robotic mitral valve surgery is slightly higher than conventional sternotomy surgery. If amortization is taken into consideration, robotic cases are considerably more expensive.
一篇心脏外科领域的最佳证据主题文章是按照结构化方案撰写的。所探讨的问题是“机器人二尖瓣手术是否比传统二尖瓣手术成本更高？”通过报告的检索方式共找到19篇论文，其中5篇代表了回答该临床问题的最佳证据。这些论文的作者、期刊、发表日期、国家、研究的患者群体、研究类型、相关结局和结果都列于表格中。外科界普遍认为机器人手术可能会产生高昂的额外成本。关于心脏机器人手术成本分析的文献资料匮乏。在这五项研究中，四项是单机构经验研究，一项是数据库查询研究。这四项研究表明，机器人手术病例的手术成本较高，但术后成本降低部分（一项研究）或完全（三项研究）抵消了这一差异。三项研究显示两种手术方式的总体医院成本相似，一项研究表明机器人手术组成本更高。手术室成本较高主要是由于使用机器人器械（每例约1500美元）以及手术时间更长。术后护理成本的节省得益于住院时间缩短（机器人手术病例平均少2天）和发病率降低。如果将摊销成本（即机器人系统初始资本投资价值除以所有进行的手术数量）纳入该分析，机器人手术方式每例成本会显著增加约3400美元。第五项研究是一项大型全国数据库查询研究，结果发现排除摊销成本时，机器人手术方式每例成本高出600美元，若包括摊销成本则高出3700美元。我们得出结论，机器人二尖瓣手术的总体医院成本略高于传统胸骨切开术。如果考虑摊销成本，机器人手术病例成本会高得多。
