AdventHealth Tampa, Tampa, FL.
AdventHealth Tampa, Tampa, FL.
J Am Coll Surg. 2021 Apr;232(4):461-469. doi: 10.1016/j.jamcollsurg.2020.12.062. Epub 2021 Feb 10.
The robotic approach to pancreaticoduodenectomy is thought by many to be associated with increased financial burden for hospitals. We undertook this study to analyze and compare the cost of "open" pancreaticoduodenectomy with that associated with the application of the robotic surgical system to pancreaticoduodenectomy in our hepatobiliary program.
With IRB approval, all patients undergoing pancreaticoduodenectomy at our institution, from August 2012 to November 2019, were prospectively followed. Cost, including total, variable, fixed-direct, fixed-indirect, and profitability for robotic and "open" pancreaticoduodenectomy were analyzed and compared. Data are presented as median (mean ± SD).
There were 386 patients who underwent pancreaticoduodenectomy; 205 patients underwent robotic pancreaticoduodenectomy and 181 underwent "open" pancreaticoduodenectomy. Costs are presented as mean ± SD. Overall, the cost of care for robotic pancreaticoduodenectomy was $31,389 ($36,611 ± $20,545.40) vs $23,132 ($31,323 ± $28,885.50) for "open" pancreaticoduodenectomy (p = 0.04); total variable cost was $20,355 ($22,747 ± $11,127.60) vs $11,680 ($16,032 ± $14,817.20) (p = 0.01), total fixed direct cost was $1,999 ($2,330 ± $1,363.10) vs $2,073 ($2,983 ± $3,209.00) (p = 0.01), and total indirect cost was $7,217 ($9,354 ± $6,802.40) vs $6,802 ($9,505 ± $9,307.20) (p = 0.86), for robotic vs "open" pancreaticoduodenectomy, respectively. Since 2016, profitability was achieved in 29% of patients undergoing robotic pancreaticoduodenectomy.
Robotic pancreaticoduodenectomy had lower estimated blood loss and shorter length of stay. Cost of care for robotic pancreaticoduodenectomy was greater across all categories, except for total indirect cost, than "open" pancreaticoduodenectomy. For our institution, profitability was accomplished in less than one-third of patients undergoing robotic pancreaticoduodenectomy. The role of the robotic platform for pancreaticoduodenectomy needs to be discussed among all stakeholders.
许多人认为机器人辅助胰十二指肠切除术与医院的经济负担增加有关。我们进行这项研究是为了分析和比较我们肝胆项目中机器人手术系统应用于胰十二指肠切除术的“开放”胰十二指肠切除术的成本。
在机构审查委员会的批准下，前瞻性地随访了 2012 年 8 月至 2019 年 11 月期间在我院接受胰十二指肠切除术的所有患者。分析并比较了机器人胰十二指肠切除术和“开放”胰十二指肠切除术的总成本、可变成本、固定直接成本、固定间接成本和盈利能力。数据以中位数（平均值±标准差）表示。
共有 386 例患者接受了胰十二指肠切除术；205 例患者接受了机器人胰十二指肠切除术，181 例患者接受了“开放”胰十二指肠切除术。成本以平均值±标准差表示。总体而言，机器人胰十二指肠切除术的治疗费用为 31389 美元（36611 美元±20545.40 美元），而“开放”胰十二指肠切除术的治疗费用为 23132 美元（31323 美元±28885.50 美元）（p=0.04）；总可变成本为 20355 美元（22747 美元±11127.60 美元），而“开放”胰十二指肠切除术的总可变成本为 11680 美元（16032 美元±14817.20 美元）（p=0.01）；总固定直接成本为 1999 美元（2330 美元±1363.10 美元），而“开放”胰十二指肠切除术的总固定直接成本为 2073 美元（2983 美元±3209.00 美元）（p=0.01）；总间接成本为 7217 美元（9354 美元±6802.40 美元），而“开放”胰十二指肠切除术的总间接成本为 6802 美元（9505 美元±9307.20 美元）（p=0.86）。自 2016 年以来，机器人胰十二指肠切除术的患者中有 29%实现了盈利。
机器人胰十二指肠切除术估计失血量更少，住院时间更短。机器人胰十二指肠切除术的治疗费用在所有类别中均高于“开放”胰十二指肠切除术，除总间接成本外。对于我们医院来说，只有不到三分之一的机器人胰十二指肠切除术患者实现了盈利。机器人平台在胰十二指肠切除术中的作用需要在所有利益相关者之间进行讨论。
