Hagen Monika E, Rohner Peter, Jung Minoa K, Amirghasemi Nicolas, Buchs Nicolas C, Fakhro Jassim, Buehler Leo, Morel Philippe
Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
Medical controlling, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
Obes Surg. 2017 Aug;27(8):2099-2105. doi: 10.1007/s11695-017-2613-x.
Robotic technology shows some promising early outcomes indicating potentially improved outcomes particularly for challenging bariatric procedures. Still, health care providers face significant clinical and economic challenges when introducing innovations.
Prospectively derived administrative cost data of patients who were coded with a primary diagnosis of obesity (ICD-10 code E.66.X), a procedure of gastric bypass surgery (CHOP code 44.3), and a robotic identifier (CHOP codes 00.90.50 or 00.39) during the years 2012 to 2015 was analyzed and compared to the triggered reimbursement for this patient cohort.
A total of 348 patients were identified. The mean number of diagnoses was 2.7 and the mean length of stay was 5.9 days. The overall mean cost per patients was Swiss Francs (CHF) from 2012 to 2014 that was 21,527, with a mean reimbursement of CHF 24,917. Cost of the surgery in 2015 was comparable to the previous years with CHF 22,550.0 (p = 0.6618), but reimbursement decreased significantly to CHF 20,499.0 (0.0001).
The average cost for robotic gastric bypass surgery fell well below the average reimbursement within the Swiss DRG system between 2012 and 2014, and this robotic procedure was a DRG winner for that period. However, the Swiss DRG system has matured over the years with a significant decrease resulting in a deficit for robotic gastric bypass surgery in 2015. This stipulates a discussion as to how health care providers should continue offering robotic gastric bypass surgery, particularly in the light of developing clinical evidence.
机器人技术显示出一些有前景的早期结果，表明其可能改善手术结果，尤其是对于具有挑战性的减肥手术。尽管如此，医疗保健提供者在引入创新技术时仍面临重大的临床和经济挑战。
分析了2012年至2015年期间主要诊断为肥胖（国际疾病分类第十版代码E.66.X）、接受胃旁路手术（CHOP代码44.3）且有机器人手术标识（CHOP代码00.90.50或00.39）的患者的前瞻性管理成本数据，并将其与该患者队列的触发式报销进行比较。
共识别出348例患者。平均诊断数为2.7，平均住院天数为5.9天。2012年至2014年每位患者的总体平均成本为21,527瑞士法郎（CHF），平均报销额为24,917瑞士法郎。2015年手术成本与前几年相当，为22,550.0瑞士法郎（p = 0.6618），但报销额显著下降至20,499.0瑞士法郎（p = 0.0001）。
2012年至2014年期间，机器人辅助胃旁路手术的平均成本远低于瑞士疾病诊断相关分组（DRG）系统内的平均报销额，该机器人手术在此期间是DRG的赢家。然而，瑞士DRG系统多年来已经成熟，报销额大幅下降，导致2015年机器人辅助胃旁路手术出现亏损。这引发了关于医疗保健提供者应如何继续提供机器人辅助胃旁路手术的讨论，特别是鉴于临床证据的不断发展。
