St. Luke's University Hospital and Health Network, Bethlehem, USA.
Lewis Katz School of Medicine, Temple University, Philadelphia, USA.
J Robot Surg. 2023 Feb;17(1):49-54. doi: 10.1007/s11701-022-01385-x. Epub 2022 Mar 19.
The use of the robotic platform in bariatric surgery remains controversial because of lack of level I evidence to support its superiority compared to the laparoscopic approach and because of cost concerns. Recently, an extended use program (EUP) for robotic instruments was also introduced at our institution to help reduce the associated direct medical costs of robotic surgery.
To evaluate the direct medical costs of a robotic sleeve gastrectomy (R-SG) and compare it to a standard laparoscopic approach (L-SG).
Academic, tertiary care center.
The analysis included the last 50 R-SG performed at our institution between June 1st 2019 and October 31st 2020. Those cases were compared to the L-SG cases (29 cases) performed in the same time period. All revisions or conversions were then excluded which resulted in a total of 74 primary SG (R-SG = 45 and L-SG = 29). Direct medical costs included operating room cost, instrument cost, miscellaneous cost, and cost of hospital stay. Direct cost data was generated using the StrataJazz reporting module, which is fed daily from EPIC, our electronic health record system. Patients who underwent a primary SG or a primary SG with a concomitant Paraesophageal Hernia Repair (PEH) were analyzed separately using Mann-Whitney rank sum tests and Student's t tests. An additional analysis and subanalysis of the groups was also performed after applying the potential savings of the Extended Use Program (EUP).
Overall, the direct medical cost of R-SG was comparable to L-SG ($6330.77 vs $6804.12 respectively, p = 0.07). The direct medical cost of patients undergoing SG alone without PEH was significantly lower in the R-group compared to the L-group ($5927.08 vs $6508.01, respectively, p = 0.04). When applying the EUP savings to our data, the predicted direct medical cost of R-SG becomes significantly lower than L-SG ($6145.77 vs $6804.12 respectively, p = 0.01).
At our academic medical center, we found no difference in direct medical costs between R-SG and L-SG. With the application of the EUP, direct medical costs of R-SG can be significantly lowered compared to L-SG. It is important to consider that cost data are largely dependent upon the academic medical center of interest, and surgeons need to collect their own cost data to evaluate whether robotic surgery is feasible at their institution.
由于缺乏一级证据支持其优于腹腔镜方法的优势，以及成本问题，机器人平台在减重手术中的应用仍然存在争议。最近，我们机构还引入了机器人器械的扩展使用计划（EUP），以帮助降低机器人手术相关的直接医疗成本。
评估机器人袖状胃切除术（R-SG）的直接医疗成本，并将其与标准腹腔镜方法（L-SG）进行比较。
学术性，三级护理中心。
分析包括 2019 年 6 月 1 日至 2020 年 10 月 31 日期间在我院进行的最后 50 例 R-SG。将这些病例与同期进行的 29 例 L-SG 病例（29 例）进行比较。然后排除所有的翻修或转换病例，最终共有 74 例原发性 SG（R-SG=45 例，L-SG=29 例）。直接医疗费用包括手术室费用、器械费用、杂项费用和住院费用。直接成本数据是使用 StrataJazz 报告模块生成的，该模块每天从我们的电子健康记录系统 EPIC 中获取。分别对接受原发性 SG 或原发性 SG 合并食管裂孔疝修复（PEH）的患者进行 Mann-Whitney 秩和检验和学生 t 检验分析。在应用扩展使用计划（EUP）的潜在节省后，还对这些组进行了额外的分析和子分析。
总体而言，R-SG 的直接医疗费用与 L-SG 相当（分别为 6330.77 美元和 6804.12 美元，p=0.07）。在未行 PEH 的 SG 患者中，R 组的直接医疗费用明显低于 L 组（分别为 5927.08 美元和 6508.01 美元，p=0.04）。当将 EUP 的节省应用于我们的数据时，R-SG 的预测直接医疗成本明显低于 L-SG（分别为 6145.77 美元和 6804.12 美元，p=0.01）。
在我们的学术医疗中心，我们没有发现 R-SG 和 L-SG 的直接医疗成本有差异。通过应用 EUP，R-SG 的直接医疗成本可以显著低于 L-SG。需要指出的是，成本数据在很大程度上取决于所关注的学术医疗中心，外科医生需要收集自己的成本数据，以评估机器人手术在其机构是否可行。
