腹腔镜胰十二指肠切除术在高容量中心是具有成本中性的。
The laparoscopic approach to pancreatoduodenectomy is cost neutral in very high-volume centers.
机构信息
Department of Surgery, Loyola University Medical Center, Maywood, IL.
Department of Surgery, University of South Florida, Tampa, FL.
出版信息
Surgery. 2019 Dec;166(6):1027-1032. doi: 10.1016/j.surg.2019.07.004. Epub 2019 Aug 28.
BACKGROUND
Little is known regarding the impact of minimally invasive approaches to pancreatoduodenectomy on the aggregate costs of care for patients undergoing pancreatoduodenectomy.
METHODS
We queried the Healthcare Cost and Utilization Project State Inpatient Database to identify patients undergoing elective laparoscopic or open pancreatoduodenectomy between 2014 and 2016.
RESULTS
In this database, 488 (10%) patients underwent elective laparoscopic; 4,544 (90%) underwent open pancreatoduodenectomy. On adjusted analysis, the risk of perioperative morbidity and overall duration of hospitalization for patients undergoing elective laparoscopic were identical to those for patients undergoing open pancreatoduodenectomy. Patients undergoing elective laparoscopic in low (+$10,399, 95% confidence interval [$3,700, $17,098]) and moderate to high (+$4,505, 95% confidence interval [$528, $8,481]) volume centers had greater costs than those undergoing open pancreatoduodenectomy in the same centers. In very high-volume centers (>127 pancreatoduodenectomies/year), aggregate costs of care for patients undergoing elective laparoscopic were essentially identical to those undergoing open pancreatoduodenectomy in the same centers (+$815, 95% confidence interval [-$1,530, $3,160]).
CONCLUSION
Rates of morbidity and overall duration of hospitalization for patients undergoing elective laparoscopic are not different than those undergoing open pancreatoduodenectomy. At low to moderate and high-volume centers, elective laparoscopic is associated with greater aggregate costs of care relative to open pancreatoduodenectomy. At very high-volume centers, elective laparoscopic is cost-neutral.
背景
对于微创胰十二指肠切除术对接受胰十二指肠切除术患者的总体治疗费用的影响，目前知之甚少。
方法
我们查询了医疗保健成本和利用项目州住院患者数据库，以确定 2014 年至 2016 年间接受择期腹腔镜或开放性胰十二指肠切除术的患者。
结果
在该数据库中，488 例（10%）患者接受择期腹腔镜手术；4544 例（90%）接受开放性胰十二指肠切除术。在调整分析中，接受择期腹腔镜手术的患者的围手术期发病率和总住院时间与接受开放性胰十二指肠切除术的患者相同。在低（+10399 美元，95%置信区间[3700 美元，17098 美元]）和中高（+4505 美元，95%置信区间[528 美元，8481 美元]）容量中心接受择期腹腔镜手术的患者的费用高于在同一中心接受开放性胰十二指肠切除术的患者。在高容量中心（>127 例胰十二指肠切除术/年），在同一中心接受择期腹腔镜手术的患者的总治疗费用与接受开放性胰十二指肠切除术的患者基本相同（+815 美元，95%置信区间[-1530 美元，3160 美元]）。
结论
接受择期腹腔镜手术的患者的发病率和总住院时间与接受开放性胰十二指肠切除术的患者没有差异。在低至中高容量中心，与开放性胰十二指肠切除术相比，择期腹腔镜手术与更高的总体治疗费用相关。在高容量中心，择期腹腔镜手术是成本中性的。
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