Harrison Oliver J, Maraschi Alessandro, Routledge Tom, Lampridis Savvas, LeReun Corinne, Bille Andrea
Thoracic Surgery Department, Guys Hospital, London, United Kingdom.
Department of Thoracic Surgery, University Hospital Southampton, Southampton, United Kingdom.
Front Surg. 2023 Apr 25;10:1123329. doi: 10.3389/fsurg.2023.1123329. eCollection 2023.
Robot-assisted thoracoscopic surgery (RATS) is an alternative to video-assessed thoracoscopic surgery (VATS) for the treatment of lung cancer but concern exists regarding the high associated costs. The COVID-19 pandemic added further financial pressure to healthcare systems. This study investigated the impact of the learning curve on the cost-effectiveness of RATS lung resection and the financial impact of the COVID-19 pandemic on a RATS program.
Patients undergoing RATS lung resection between January 2017 and December 2020 were prospectively followed. A matched cohort of VATS cases were analyzed in parallel. The first 100 and most recent 100 RATS cases performed at our institution were compared to assess the learning curve. Cases performed before and after March 2020 were compared to assess the impact of the COVID-19 pandemic. A comprehensive cost analysis of multiple theatre and postoperative data points was performed using Stata statistics package (v14.2).
365 RATS cases were included. Median cost per procedure was £7,167 and theatre cost accounted for 70%. Major contributing factors to overall cost were operative time and postoperative length of stay. Cost per case was £640 less after passing the learning curve ( < 0.001) largely due to reduced operative time. Comparison of a post-learning curve RATS subgroup matched to 101 VATS cases revealed no significant difference in theatre costs between the two techniques. Overall cost of RATS lung resections performed before and during the COVID-19 pandemic were not significantly different. However, theatre costs were significantly cheaper (£620/case; < 0.001) and postoperative costs were significantly more expensive (£1,221/case; = 0.018) during the pandemic.
Passing the learning curve is associated with a significant reduction in the theatre costs associated with RATS lung resection and is comparable with the cost of VATS. This study may underestimate the true cost benefit of passing the learning curve due to the effect of the COVID-19 pandemic on theatre costs. The COVID-19 pandemic made RATS lung resection more expensive due to prolonged hospital stay and increased readmission rate. The present study offers some evidence that the initial increased costs associated with RATS lung resection may be gradually offset as a program progresses.
机器人辅助胸腔镜手术（RATS）是治疗肺癌的一种替代视频辅助胸腔镜手术（VATS）的方法，但人们对其高昂的相关成本存在担忧。2019冠状病毒病疫情给医疗系统带来了进一步的财政压力。本研究调查了学习曲线对RATS肺切除术成本效益的影响以及2019冠状病毒病疫情对一个RATS项目的财务影响。
对2017年1月至2020年12月期间接受RATS肺切除术的患者进行前瞻性随访。同时对一组匹配的VATS病例进行平行分析。比较在我们机构进行的前100例和最近100例RATS病例以评估学习曲线。比较2020年3月之前和之后进行的病例以评估2019冠状病毒病疫情的影响。使用Stata统计软件包（v14.2）对多个手术室和术后数据点进行全面成本分析。
纳入365例RATS病例。每例手术的中位成本为7167英镑，手术室成本占70%。总体成本的主要影响因素是手术时间和术后住院时间。越过学习曲线后，每例成本降低了640英镑（<0.001），这主要是由于手术时间缩短。将越过学习曲线后的RATS亚组与101例VATS病例进行比较，发现两种技术在手术室成本方面没有显著差异。2019冠状病毒病疫情之前和期间进行的RATS肺切除术的总体成本没有显著差异。然而，在疫情期间，手术室成本显著降低（每例620英镑；<0.001），而术后成本显著增加（每例1221英镑；=0.018）。
越过学习曲线与RATS肺切除术相关的手术室成本显著降低有关，并且与VATS的成本相当。由于2019冠状病毒病疫情对手术室成本的影响，本研究可能低估了越过学习曲线的真正成本效益。2019冠状病毒病疫情使RATS肺切除术变得更加昂贵，原因是住院时间延长和再入院率增加。本研究提供了一些证据表明，随着一个项目的推进，与RATS肺切除术相关的最初增加的成本可能会逐渐得到抵消。
