Daskalaki Despoina, Gonzalez-Heredia Raquel, Brown Marc, Bianco Francesco M, Tzvetanov Ivo, Davis Myriam, Kim Jihun, Benedetti Enrico, Giulianotti Pier C
1 Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago , Chicago, Illinois.
2 AlixPartners, Chicago, Illinois.
J Laparoendosc Adv Surg Tech A. 2017 Apr;27(4):375-382. doi: 10.1089/lap.2016.0576. Epub 2017 Feb 10.
BACKGROUND: One of the perceived major drawbacks of minimally invasive techniques has always been its cost. This is especially true for the robotic approach and is one of the main reasons that has prevented its wider acceptance among hospitals and surgeons. The aim of our study was to evaluate the clinical outcomes and economic impact of robotic and open liver surgery in a single institution. METHODS: Sixty-eight robotic and 55 open hepatectomies were performed at our institution between January 1, 2009 and December 31, 2013. Demographics, perioperative data, and postoperative outcomes were collected and compared between the two groups. An independent company performed the financial analysis. The economic parameters comprised direct variable costs, direct fixed costs, and indirect costs. RESULTS: Mean estimated blood loss was significantly less in the robotic group (438 versus 727.8 mL; P = .038). Overall morbidity was significantly lower in the robotic group (22% versus 40%; P = .047). Clavien III/IV complications were also lower, with 4.4% in the robotic versus 16.3% in the open group (P = .043). The length of stay in the intensive care unit (ICU) was shorter for patients who underwent a robotic procedure (2.1 versus 3.3 days; P = .004). The average total cost, including readmissions, was $37,518 for robotic surgery and $41,948 for open technique. CONCLUSIONS: Robotic liver resections had less overall morbidity, ICU, and hospital stay. This translates into decreased average costs for robotic surgery. These procedures are financially comparable to open resections and do not represent a financial burden to the hospital.
背景:微创技术一直被认为的主要缺点之一就是其成本。对于机器人手术方法来说尤其如此,这也是阻碍其在医院和外科医生中更广泛被接受的主要原因之一。我们研究的目的是评估在单一机构中机器人肝脏手术和开放肝脏手术的临床结果及经济影响。 方法:2009年1月1日至2013年12月31日期间,我们机构进行了68例机器人肝切除术和55例开放肝切除术。收集两组的人口统计学、围手术期数据和术后结果并进行比较。由一家独立公司进行财务分析。经济参数包括直接可变成本、直接固定成本和间接成本。 结果:机器人手术组的平均估计失血量显著更少(438毫升对727.8毫升;P = 0.038)。机器人手术组的总体发病率显著更低(22%对40%;P = 0.047)。Clavien III/IV级并发症也更低,机器人手术组为4.4%,开放手术组为16.3%(P = 0.043)。接受机器人手术的患者在重症监护病房(ICU)的住院时间更短(2.1天对3.3天;P = 0.004)。包括再次入院在内的机器人手术平均总成本为37,518美元,开放手术技术为41,948美元。 结论:机器人肝脏切除术的总体发病率、ICU住院时间和住院时间更短。这意味着机器人手术的平均成本降低。这些手术在经济上与开放切除术相当,对医院不构成经济负担。
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