Agarwal Reshu, Rajanbabu Anupama, Unnikrishnan U G
Department of Gynecologic Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
J Robot Surg. 2018 Dec;12(4):665-672. doi: 10.1007/s11701-018-0799-0. Epub 2018 Mar 22.
To compare the usage and cost of analgesics (opioid and non-opioids), antiemetics, and IV fluids and its associated costs in robotic vs open staging surgery for endometrial cancer (EC). This retrospective study was performed at a single academic institution from January 2014 to June 2017 in the department of Gynecology Oncology at Amrita Institute of Medical Science, Kerala, India. The study included women with biopsy confirmed clinically early stage endometrial cancer or atypical hyperplasia, who underwent robotic-assisted or open staging surgery. Data on surgical time, blood loss, post-anaesthesia care unit (PACU) stay, and length of hospital (LOH) stay; analgesic, antiemetic, and IV fluid use were collected for three distinct periods: intra-operative, PACU, and ward. Direct medicine and material costs associated with the administration of intravenous (IV) fluids, analgesics, and antiemetics were collected. All parameters were compared between two surgical groups. The study included 133 (54 open and 79 robotic-assisted) patients. As compared to open surgery, robotic-assisted surgery was associated with significantly reduced: surgical time (p = 0.007), estimated blood loss (p < 0.001), PACU stay (p < 0.001), LOH stay (p < 0.001); IV fluids (crystalloid and colloid; p < 0.001); opioids (p < 0.001), non-opioids (intravenous acetaminophen, oral acetaminophen, diclofenac; all p < 0.001); incidence of post-operative nausea and vomiting and the requirement of rescue antiemetics (p < 0.001). EC staging using robotic-assisted surgery was associated with significantly lower medicine and material costs attributed to IV fluids, analgesia, and antiemetics (p < 0.001). As compared to open surgery, robotic surgery was associated with the total saving of $107.7 ($19.5 in IV fluids, $49.2 in analgesics, $1.33 in antiemetics, and $37.8 in material). Robotic-assisted surgical staging for endometrial cancer is associated with decreased requirement and expenditure attributable to post-operative pain, post-operative nausea and vomiting, and maintenance and replacement fluid therapy.
比较子宫内膜癌（EC）机器人分期手术与开放分期手术中镇痛药（阿片类和非阿片类）、止吐药及静脉输液的使用情况、费用及其相关成本。这项回顾性研究于2014年1月至2017年6月在印度喀拉拉邦阿姆里塔医学科学研究所妇科肿瘤学系的一家学术机构进行。该研究纳入了经活检确诊为临床早期子宫内膜癌或非典型增生且接受了机器人辅助或开放分期手术的女性。收集了手术时间、失血量、麻醉后护理单元（PACU）停留时间和住院时间（LOH）的数据；以及三个不同时期（术中、PACU和病房）的镇痛药、止吐药和静脉输液使用情况。收集了与静脉输液、镇痛药和止吐药给药相关的直接药品和材料成本。对两个手术组的所有参数进行了比较。该研究纳入了133例患者（54例开放手术和79例机器人辅助手术）。与开放手术相比，机器人辅助手术的手术时间显著缩短（p = 0.007）、估计失血量显著减少（p < 0.001）、PACU停留时间显著缩短（p < 0.001）、住院时间显著缩短（p < 0.001）；静脉输液（晶体液和胶体液；p < 0.001）；阿片类药物（p < 0.001）、非阿片类药物（静脉注射对乙酰氨基酚、口服对乙酰氨基酚、双氯芬酸；均p < 0.001）；术后恶心呕吐的发生率及急救止吐药的需求显著降低（p < 0.001）。机器人辅助手术进行EC分期与静脉输液、镇痛和止吐药相关的药品和材料成本显著降低有关（p < 0.001）。与开放手术相比，机器人手术总共节省了107.7美元（静脉输液节省19.5美元、镇痛药节省49.2美元、止吐药节省1.33美元、材料节省37.8美元）。子宫内膜癌的机器人辅助手术分期与术后疼痛、术后恶心呕吐以及维持和补充液体治疗的需求和费用降低有关。
