Mehdorn Matthias, Schürmann Olaf, Mehdorn H Maximilian, Gockel Ines
Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
Department of Surgery, Clinic for Visceral, Transplant, Thoracic and Vascular Surgery, UKL, University Hospital of Leipzig, Liebig Strasse 20, 04103, Leipzig, Germany.
BMC Surg. 2017 Jul 11;17(1):80. doi: 10.1186/s12893-017-0277-z.
Cost reduction measures in medicine are gaining greater importance nowadays, especially in high-volume procedures such as laparoscopic appendectomy (LAE). Currently there are two common methods of dissecting the appendix from the caecal pole: linear stapler and endoloops. The endoloop is the cheaper device but can only be used in uncomplicated cases of appendicitis. Therefore both methods are used in LAE depending on intraoperative findings. The goal of this study was to retrospectively evaluate possible cost reduction due to increased use of endoloop in LAE in our general surgery department of a tertiary referral university hospital.
We previously used the stapler for appendix dissection in LAE as our local protocol but introduced the endoloop as standard method in 2015 to reduce intraoperative costs. We conducted a retrospective analysis of patients who underwent LAE between June 2014 and October 2015 in our department. Our purpose is to show the effects on cost reduction during the introductory period adjusting for a potential bias due to the individual learning curve of every surgeon. We estimated costs for LAE by taking into account average device costs and duration of operation (DO) as well as patient outcome.
A total of 177 patients underwent LAE, 73 in 2014 (phase I) and 104 in 2015 (phase II). The median DO was 61 (± 24 SD) min during the entire period, and increased by 14 min from phase I to II (from 51 (±23 SD) min to 65 (±24 SD) min respectively, p < 0.001). The use of endoloops increased from 10% to 55% (p < 0.001). Patients' characteristics and outcomes did not differ significantly. A median saving of 5.9€ per operation was calculated in phase II compared to phase I (p = 0.80).
Introducing the endoloop as standard device for LAE leads to a marginal reduction in intraoperative costs without increasing negative outcomes. In our model the cost-reduction achieved by cheaper devices was overcome by increased costs for DO during the initial phase of use of endoloops. A longer follow up might show a more pronounced cost reduction.
如今，医学领域的成本削减措施愈发重要，尤其是在诸如腹腔镜阑尾切除术（LAE）这类高流量手术中。目前，从盲肠极处游离阑尾有两种常用方法：直线切割吻合器和圈套器。圈套器是较便宜的器械，但仅适用于单纯性阑尾炎病例。因此，在LAE中会根据术中情况使用这两种方法。本研究的目的是回顾性评估在一所三级转诊大学医院的普通外科中，LAE中增加圈套器的使用可能带来的成本降低情况。
我们之前按照当地规程在LAE中使用吻合器进行阑尾游离，但在2015年引入圈套器作为标准方法以降低术中成本。我们对2014年6月至2015年10月在我科接受LAE的患者进行了回顾性分析。我们的目的是在考虑到每位外科医生个体学习曲线导致的潜在偏倚的情况下，展示引入期内对成本降低的影响。我们通过考虑平均器械成本、手术时长（DO）以及患者预后情况来估算LAE的成本。
共有177例患者接受了LAE，2014年（第一阶段）有73例，2015年（第二阶段）有104例。整个期间的中位手术时长为61（±24标准差）分钟，从第一阶段到第二阶段增加了14分钟（分别从51（±23标准差）分钟增至65（±24标准差）分钟，p < 0.001）。圈套器的使用比例从10%增至55%（p < 0.001）。患者的特征和预后无显著差异。与第一阶段相比，第二阶段计算得出每次手术中位节省5.9欧元（p = 0.80）。
将圈套器作为LAE的标准器械可使术中成本略有降低，且不会增加不良后果。在我们的模型中，在使用圈套器的初始阶段，因器械成本降低所实现的成本节约被手术时长增加带来的成本上升所抵消。更长时间的随访可能会显示出更显著的成本降低。
