Sosa Michelle P, McNicholas Deirdre G, Bebla Arbelina B, Needham Keith A, Starker Paul M
Stryker Endoscopy, San Jose, CA.
Baker Tilly US, LLP, New York, NY, USA.
Surg Open Sci. 2022 Sep 25;10:158-164. doi: 10.1016/j.sopen.2022.09.007. eCollection 2022 Oct.
The purpose of this study is to assess which minimally invasive colon surgery approach may be associated with the least 30- and 90-day inpatient readmission costs from a payer perspective.
This retrospective claims analysis included adult Medicare and commercially insured beneficiaries who underwent minimally invasive sigmoid, left, or right colon surgery between January 2016 and December 2019. Two cohorts were created based on the use of near-infrared fluorescence (NIF) and were propensity-score matched 1 NIF:5 NoNIF. Four subgroups were then created based on the presence of robotics (R): NIF-NoR, NIF-R, NoNIF-R, and NoNIF-NoR.
A total of 50,148 patients were identified, of which 165 (0.3%) indicated the use of NIF and 49,983 (99.7%) did not. After propensity score matching, 990 patients were included (NIF cohort: 165; NoNIF cohort: 825). Of the 165 NIF patients, 87 were robotic-assisted and 78 were conventional laparoscopy. Of the 825 NoNIF patients, 136 were robotic-assisted and 689 were conventional laparoscopy. Postindex inpatient readmission costs were significantly different between the NIF and NoNIF cohorts with the NIF cohort having the lowest 30- and 90-day postindex readmission costs. Postindex readmission costs were also significantly different across the 4 subgroups at 30 and 90 days, with the NIF-NoR group having the lowest postindex readmission costs (all P < .05).
Using NIF without the robot during minimally invasive colon surgery is associated with the least 30- and 90-day inpatient readmission costs compared to the other 3 approaches. Hospitals may want to consider these potential cost savings when evaluating technologies for laparoscopic colon surgery.
Near-infrared fluorescence (NIF) imaging without the robot during minimally invasive colon surgery may significantly save hospitals 30- and 90-day inpatient readmission costs compared to NIF with the robot, NoNIF with the robot, and NoNIF without the robot. This is important as hospitals may want to consider these cost findings in addition to capital equipment and disposable costs when evaluating technologies for laparoscopic colon surgery.
本研究的目的是从支付方的角度评估哪种微创结肠手术方法可能与30天和90天住院再入院成本最低相关。
这项回顾性索赔分析纳入了2016年1月至2019年12月期间接受微创乙状结肠、左半结肠或右半结肠手术的成年医疗保险和商业保险受益患者。根据近红外荧光（NIF）的使用情况创建了两个队列，并进行倾向评分匹配，1个NIF组：5个非NIF组。然后根据机器人技术（R）的存在情况创建了四个亚组：NIF-无R组、NIF-R组、非NIF-R组和非NIF-无R组。
共识别出50148例患者，其中165例（0.3%）使用了NIF，49983例（99.7%）未使用。倾向评分匹配后，纳入990例患者（NIF队列：165例；非NIF队列：825例）。在165例NIF患者中，87例为机器人辅助手术，78例为传统腹腔镜手术。在825例非NIF患者中，136例为机器人辅助手术，689例为传统腹腔镜手术。索引后住院再入院成本在NIF和非NIF队列之间存在显著差异，NIF队列的30天和90天索引后再入院成本最低。索引后再入院成本在30天和90天时的4个亚组之间也存在显著差异，NIF-无R组的索引后再入院成本最低（所有P<0.05）。
与其他三种方法相比，在微创结肠手术中使用无机器人的NIF与30天和90天住院再入院成本最低相关。医院在评估腹腔镜结肠手术技术时，可能需要考虑这些潜在的成本节约。
与使用机器人的NIF、使用机器人的非NIF以及不使用机器人的非NIF相比，在微创结肠手术中不使用机器人的近红外荧光（NIF）成像可能会显著节省医院30天和90天的住院再入院成本。这很重要，因为医院在评估腹腔镜结肠手术技术时，除了资本设备和一次性成本外，可能还需要考虑这些成本发现。
