Fu Sue J, Ho Vanessa P, Ginsberg Jennifer, Perry Yaron, Delaney Conor P, Linden Philip A, Towe Christopher W
Division of Thoracic and Esophageal Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, OH, USA.
Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, OH, USA.
Minim Invasive Surg. 2016;2016:7690632. doi: 10.1155/2016/7690632. Epub 2016 Dec 8.
. Minimally invasive esophagectomy (MIE) techniques offer similar oncological and surgical outcomes to open methods. The effects of MIE on hospital costs are not well documented. . We reviewed the electronic records of patients who underwent esophagectomy at a single academic institution between January 2012 and December 2014. Esophagectomy techniques were grouped into open, hybrid, MIE, and transhiatal (THE) esophagectomy. Univariate and multivariate analyses were performed to assess the impact of surgery on total hospital cost after esophagectomy. . 80 patients were identified: 11 THE, 11 open, 41 hybrid, and 17 MIE. Median total cost of the hospitalization was $31,375 and was similar between surgical technique groups. MIE was associated with higher intraoperative costs, but not total hospital cost. Multivariable analysis revealed that the presence of a complication, increased age, American Society of Anesthesiologists class IV (ASA4), and preoperative coronary artery disease (CAD) were associated with significantly increased cost. . Despite the association of MIE with higher operation costs, the total hospital cost was not different between surgical technique groups. Postoperative complications and severe preoperative comorbidities are significant drivers of hospital cost associated with esophagectomy. Surgeons should choose technique based on clinical factors, rather than cost implications.
微创食管切除术（MIE）技术与开放手术方法相比，在肿瘤学和手术效果方面相似。MIE对医院成本的影响尚无充分记录。我们回顾了2012年1月至2014年12月期间在单一学术机构接受食管切除术的患者的电子病历。食管切除术技术分为开放、杂交、MIE和经裂孔（THE）食管切除术。进行单因素和多因素分析以评估手术对食管切除术后总住院费用的影响。共确定了80例患者：11例THE、11例开放手术、41例杂交手术和17例MIE。住院总费用中位数为31375美元，各手术技术组之间相似。MIE与术中费用较高相关，但与总住院费用无关。多变量分析显示，出现并发症、年龄增加、美国麻醉医师协会IV级（ASA4）以及术前冠状动脉疾病（CAD）与费用显著增加相关。尽管MIE与较高的手术费用相关，但各手术技术组之间的总住院费用并无差异。术后并发症和严重的术前合并症是食管切除术后住院费用的重要驱动因素。外科医生应根据临床因素而非费用影响来选择技术。
