比较经口内镜肌切开术和腹腔镜 Heller 肌切开术的成本和结果。
Comparing cost and outcomes between peroral endoscopic myotomy and laparoscopic heller myotomy.
机构信息
Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI Suite B665, Evanston, IL, 60201, United States; Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Avenue, Chicago, IL, 60637, United States.
Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI Suite B665, Evanston, IL, 60201, United States; Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Avenue, Chicago, IL, 60637, United States.
出版信息
Am J Surg. 2021 Jul;222(1):208-213. doi: 10.1016/j.amjsurg.2020.10.037. Epub 2020 Nov 4.
BACKGROUND
Peroral endoscopic myotomy (POEM) has previously been shown to be equally if not more expensive than laparoscopic Heller myotomy (LHM). We compare perioperative outcomes and charges between POEM and LHM at a single institution.
METHODS
Outcomes and charge data of 33 patients who underwent LHM and 126 patients who underwent POEM were analyzed. Patients who did not present electively were excluded.
RESULTS
There were no demographic differences between groups. Patients who underwent POEM had a significantly shorter mean operative time and median length of stay (both p < 0.001). Patients who underwent POEM stopped narcotics earlier and had faster return to activities of daily living (both p < 0.05). When adjusted for inflation, POEM incurred less in hospital charges than LHM (35.5 ± 12.8 vs 30.7 ± 10.3 in thousands of US dollars, p = 0.006).
CONCLUSIONS
Patients who underwent POEM compared to LHM had significantly better perioperative outcomes. Our results suggest POEM may be the more cost-effective option.
背景
经口内镜下肌切开术（POEM）先前已被证明与腹腔镜 Heller 肌切开术（LHM）的费用相当，甚至更昂贵。我们在单家机构比较了 POEM 和 LHM 的围手术期结果和费用。
方法
分析了 33 例行 LHM 和 126 例行 POEM 的患者的结果和费用数据。排除了非选择性就诊的患者。
结果
两组患者在人口统计学方面没有差异。POEM 组的平均手术时间和中位住院时间明显缩短（均 p<0.001）。POEM 组更早停止使用麻醉药物，更快恢复日常生活活动（均 p<0.05）。经通胀调整后，POEM 的住院费用低于 LHM（35500±12800 与 30700±10300 美元，p=0.006）。
结论
与 LHM 相比，POEM 组患者的围手术期结果明显更好。我们的结果表明 POEM 可能是更具成本效益的选择。
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