微创远端胰腺切除术：机器人辅助手术与直接手动腹腔镜手术的病例匹配成本分析。
Minimally invasive distal pancreatectomy: a case-matched cost-analysis between robot-assisted surgery and direct manual laparoscopy.
机构信息
General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy.
Multidisciplinary Center of Robotic Surgery, University Hospital of Pisa, Pisa, Italy.
出版信息
Surg Endosc. 2022 Jan;36(1):651-662. doi: 10.1007/s00464-021-08332-1. Epub 2021 Feb 3.
BACKGROUND
Few studies have reported a structured cost analysis of robotic distal pancreatectomy (RDP), and none have compared the relative costs between the robotic-assisted surgery (RAS) and the direct manual laparoscopy (DML) in this setting. The aim of the present study is to address this issue by comparing surgical outcomes and costs of RDP and laparoscopic distal pancreatectomies (LDP).
METHODS
Eighty-eight RDP and 47 LDP performed between January 2008 and January 2020 were retrospectively analyzed. Three comparable groups of 35 patients each (Si-RDP-group, Xi-RDP group, LDP-group) were obtained matching 1:1 the RDP-groups with the LDP-group. Overall costs, including overall variable costs (OVC) and fixed costs were compared using generalized linear regression model adjusting for covariates.
RESULTS
The conversion rate was significantly lower in the Si-RDP-group and Xi-RDP-group: 2.9% and 0%, respectively, versus 14.3% in the LDP-group (p = 0.045). Although not statistically significant, the mean operative time was lower in Xi-RDP-group: 226 min versus 262 min for Si-RDP-group and 247 min for LDP-group. The overall post-operative complications rate and the length of hospital stay (LOS) were not significantly different between the three groups. In LDP-group, the LOS of converted cases was significantly longer: 15.6 versus 9.8 days (p = 0.039). Overall costs of LDP-group were significantly lower than RDP-groups, (p < 0.001). At multivariate analysis OVC resulted no longer statistically significantly different between LDP-group and Xi-RDP-group (p = 0.099), and between LDP-group and the RDP-groups when the spleen preservation was indicated (p = 0.115 and p = 0.261 for Si-RDP-group and Xi-RDP-group, respectively).
CONCLUSIONS
RAS is more expensive than DML for DP because of higher acquisition and maintenance costs. The flattening of these differences considering only the variable costs, in a high-volume multidisciplinary center for RAS, suggests a possible optimization of the costs in this setting. RAS might be particularly indicated for minimally invasive DP when the spleen preservation is scheduled.
背景
很少有研究报告过机器人辅助远端胰腺切除术（RDP）的结构化成本分析，也没有研究比较过这种情况下机器人辅助手术（RAS）和直接手动腹腔镜（DML）之间的相对成本。本研究旨在通过比较 RDP 和腹腔镜远端胰腺切除术（LDP）的手术结果和成本来解决这一问题。
方法
回顾性分析了 2008 年 1 月至 2020 年 1 月期间进行的 88 例 RDP 和 47 例 LDP。通过 1:1 匹配 RDP 组与 LDP 组，获得了 3 组各 35 例可比患者（Si-RDP 组、Xi-RDP 组和 LDP 组）。使用广义线性回归模型调整协变量比较总费用，包括总变动成本（OVC）和固定成本。
结果
Si-RDP 组和 Xi-RDP 组的转化率明显较低：分别为 2.9%和 0%，而 LDP 组为 14.3%（p=0.045）。虽然没有统计学意义，但 Xi-RDP 组的手术时间较短：226 分钟，而 Si-RDP 组为 262 分钟，LDP 组为 247 分钟。三组患者的总术后并发症发生率和住院时间（LOS）无显著差异。在 LDP 组中，中转病例的 LOS 明显更长：15.6 天比 9.8 天（p=0.039）。LDP 组的总费用明显低于 RDP 组（p<0.001）。多变量分析显示，当保留脾脏时，LDP 组与 Xi-RDP 组之间的 OVC 不再有统计学差异（p=0.099），与 RDP 组之间也不再有统计学差异（p=0.115 和 p=0.261 分别为 Si-RDP 组和 Xi-RDP 组）。
结论
由于更高的购置和维护成本，RAS 比 DML 用于 DP 更昂贵。在一个高容量的多学科 RAS 中心，仅考虑变动成本会使这些差异趋于平坦，这表明在这种情况下可能需要优化成本。当计划保留脾脏时，RAS 可能特别适用于微创 DP。
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