Newman Richard M, Umer Affan, Bozzuto Bethany J, Dilungo Jennifer L, Ellner Scott
Department of Surgery, Saint Francis Hospital, Hartford, CT; Department of Surgery, University of Connecticut Health Center, Hartford, CT.
Department of Surgery, Saint Francis Hospital, Hartford, CT; Department of Surgery, University of Connecticut Health Center, Hartford, CT.
J Am Coll Surg. 2016 Mar;222(3):303-8. doi: 10.1016/j.jamcollsurg.2015.12.016. Epub 2015 Dec 21.
As the cost of health care is subjected to increasingly greater scrutiny, the assessment of new technologies must include the surgical value (SV) of the procedure. Surgical value is defined as outcome divided by cost.
The cost and outcome of 50 consecutive traditional (4-port) laparoscopic cholecystectomies (TLC) were compared with 50 consecutive, nontraditional laparoscopic cholecystectomies (NTLC), between October 2012 and February 2014. The NTLC included SILS (n = 11), and robotically assisted single-incision cholecystectomies (ROBOSILS; n = 39). Our primary outcomes included minimally invasive gallbladder removal and same-day discharge. Thirty-day emergency department visits or readmissions were evaluated as a secondary outcome. The direct variable surgeon costs (DVSC) were distilled from our hospital cost accounting system and calculated on a per-case, per item basis.
The average DVSC for TLC was $929 and was significantly lower than NTLC at $2,344 (p < 0.05), SILS at $1,407 (p < 0.05), and ROBOSILS at $2,608 (p < 0.05). All patients achieved the same primary outcomes: minimally invasive gallbladder removal and same day discharge. There were no differences observed in secondary outcomes in 30-day emergency department visits (TLC [2%] vs NTLC [6%], p = 0.61) or readmissions (TLC [4%] vs NTLC [2%], p > 0.05), respectively. The relative SV was significantly higher for TLC (1) compared with NTLC (0.34) (p < 0.05), and SILS (0.66) and ROBOSILS (0.36) (p < 0.05).
Nontraditional, minimally invasive gallbladder removal (SILS and ROBOSILS) offers significantly less surgical value for elective, outpatient gallbladder removal.
随着医疗保健成本受到越来越严格的审查，新技术的评估必须包括手术的手术价值（SV）。手术价值定义为结果除以成本。
在2012年10月至2014年2月期间，将50例连续的传统（4孔）腹腔镜胆囊切除术（TLC）的成本和结果与50例连续的非传统腹腔镜胆囊切除术（NTLC）进行比较。NTLC包括单孔腹腔镜手术（SILS，n = 11）和机器人辅助单孔胆囊切除术（ROBOSILS，n = 39）。我们的主要结果包括微创胆囊切除和当日出院。将30天内急诊就诊或再入院作为次要结果进行评估。直接可变外科医生成本（DVSC）从我们医院的成本核算系统中提取，并按病例、按项目计算。
TLC的平均DVSC为929美元，显著低于NTLC的2344美元（p < 0.05）、SILS的1407美元（p < 0.05）和ROBOSILS的2608美元（p < 0.05）。所有患者均实现了相同的主要结果：微创胆囊切除和当日出院。在30天急诊就诊的次要结果方面未观察到差异（TLC [2%] 对NTLC [6%]，p = 0.61），再入院方面也未观察到差异（TLC [4%] 对NTLC [2%]，p > 0.05）。与NTLC（0.34）（p < 0.05）、SILS（0.66）和ROBOSILS（0.36）（p < 0.05）相比，TLC的相对SV显著更高（1）。
非传统的微创胆囊切除术（SILS和ROBOSILS）对于择期门诊胆囊切除术而言，手术价值显著较低。
