评估机器人辅助经胸食管切除术与“非机器人”辅助经胸食管切除术的成本。
Evaluating the Cost for Robotic vs "Non-Robotic" Transhiatal Esophagectomy.
机构信息
Digestive Health Institute, Tampa, FL, USA.
Department of General Surgery, 64850Assuta Medical Center, Ashdod, Israel.
出版信息
Am Surg. 2022 Mar;88(3):389-393. doi: 10.1177/00031348211046885. Epub 2021 Nov 18.
INTRODUCTION
This study was undertaken to analyze and compare the cost of robotic transhiatal esophagectomy (THE) to "non-robotic" THE (ie, "open" and laparoscopic).
METHODS
With IRB approval, we prospectively followed 82 patients who underwent THE. We analyzed clinical outcomes and perioperative charges and costs associated with THE. To compare profitability, the robotic approach was analyzed against "non-robotic" approaches of THE using F-test, Mann-Whitney U test/Student's t-test, and Fisher's exact test. Statistical significance was reported as ≤0.05. Data are presented as median (mean ± SD).
RESULTS
67 patients underwent the robotic approach, and 15 patients underwent "non-robotic" approach; 4 were "open" and 11 were laparoscopic. 79 patients had adenocarcinoma. Operative duration for robotic THE was 327 (331 ± 82.8) vs 213 (225 ± 62.0) minutes ( = 0.0001) and estimated blood loss was 150 (184 ± 136.1) vs 300 (476 ± 708.7) mL ( = 0.0001). Length of stay was 7 (11 ± 11.8) vs 8 (12 ± 10.6) days ( = 0.76). 16 patients had post-operative complications with a Clavien-Dindo score of three or more. Hospital charges for robotic THE were $197,405 ($259,936 ± 203,630.8) vs "non-robotic" THE $159,588 ($201,565 ± $185,763.5) ( = 0.31). Cost of care for robotic THE was $34,822 ($48,844 ± $45,832.8) vs "non-robotic" THE was $23,939 ($39,386 ± $44,827.2) ( = 0.47). Payment received for robotic THE was $14,365 ($30,003 ± $40,874.7) vs "non-robotic" THE was $28,080 ($41,087 ± $44,509.1) ( = 0.41). 15% of robotic operations were profitable vs 13% of "non-robotic" operations.
CONCLUSIONS
Patients were predominantly older overweight men who had adenocarcinoma of the esophagus. The robotic approach had increased operative time and minimal blood loss. More than a fourth of operations included concomitant procedures. Patients were discharged approximately one week after THE. Overall, the robotic approach has no apparent significant differences in charges, cost, or profitability.
简介
本研究旨在分析和比较机器人经食管裂孔食管切除术（THE）与“非机器人”THE（即“开放”和腹腔镜）的成本。
方法
在获得机构审查委员会批准后，我们前瞻性地随访了 82 例接受 THE 的患者。我们分析了 THE 的临床结果和围手术期费用。为了比较盈利能力，使用 F 检验、Mann-Whitney U 检验/学生 t 检验和 Fisher 确切检验对机器人方法与 THE 的“非机器人”方法进行了分析。报告统计学意义为 ≤0.05。数据以中位数（均值±标准差）表示。
结果
67 例患者接受机器人方法，15 例患者接受“非机器人”方法；4 例为“开放”，11 例为腹腔镜。79 例患者患有腺癌。机器人 THE 的手术时间为 327（331±82.8）分钟，而“非机器人”THE 的手术时间为 213（225±62.0）分钟（ = 0.0001），估计出血量为 150（184±136.1）毫升，而“非机器人”THE 的出血量为 300（476±708.7）毫升（ = 0.0001）。住院时间为 7（11±11.8）天，而“非机器人”THE 的住院时间为 8（12±10.6）天（ = 0.76）。16 例患者术后并发症严重程度为 Clavien-Dindo 评分≥3 分。机器人 THE 的住院费用为 197405 美元（259936±203630.8），而“非机器人”THE 的住院费用为 159588 美元（201565±185763.5）（ = 0.31）。机器人 THE 的治疗费用为 34822 美元（48844±45832.8），而“非机器人”THE 的治疗费用为 23939 美元（39386±44827.2）（ = 0.47）。机器人 THE 的支付金额为 14365 美元（30003±40874.7），而“非机器人”THE 的支付金额为 28080 美元（41087±44509.1）（ = 0.41）。机器人手术中 15%是盈利的，而非机器人手术中 13%是盈利的。
结论
患者主要为年龄较大、超重的男性，患有食管腺癌。机器人方法的手术时间较长，出血量较少。超过四分之一的手术包括同时进行的手术。患者在 THE 后大约一周出院。总体而言，机器人方法在费用、成本或盈利能力方面没有明显差异。
Zotero 插件