Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland.
Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Via la Santa 1, 6900, Lugano, Switzerland.
Obes Surg. 2024 Oct;34(10):3694-3702. doi: 10.1007/s11695-024-07477-x. Epub 2024 Aug 27.
Robotic bariatric surgery has not shown significant advantages compared to laparoscopy, yet costs remain a major concern. The aim of our study was to assess costs of robotic and laparoscopic bariatric surgery.
We retrospectively collected data of all patients who underwent either robotic or laparoscopic bariatric surgery at our institution. We retrieved demographics, clinical characteristics, postoperative data, and costs using a bottom-up approach. The primary endpoint was hospital costs in the robotic and laparoscopic groups. Data was analyzed using a propensity score matching.
Out of the total 122 patients enrolled in the study, 42 were subsequently chosen based on propensity scores, with 21 patients allocated to each group. No difference in clinical characteristics and postoperative outcomes were noted. Length of hospital stay was 2.4 ± 0.7 days vs. 2.6 ± 1.1 days (p = 0.520). In the robotic and laparoscopic groups, total costs were USD 16,275 ± 4018 vs. 12,690 ± 2834 (absolute difference USD 3585, 95%CI 1416-5753, p = 0.002), direct costs were USD 5037 ± 1282 vs. 3720 ± 1308 (absolute difference USD 1316, 95% CI 509-2214, p = 0.002), and indirect costs were USD 11,238 ± 3234 vs. 8970 ± 3021 (absolute difference USD 2,268, 95% CI 317-4220, p = 0.024). Subgroup analyses revealed a decreasing trend in the cost difference in patients undergoing primary gastric bypass and revisional surgery.
Overall hospital costs were higher in patients operated on with the robotic system than with laparoscopy, yet a clinical advantage has not been demonstrated so far. Subgroup analyses showed lesser disparity in costs among patients undergoing revisional bariatric surgery, where robotics are likely to be more worthwhile.
与腹腔镜相比，机器人减重手术并没有显示出显著的优势，但成本仍然是一个主要关注点。本研究的目的是评估机器人和腹腔镜减重手术的成本。
我们回顾性地收集了在我院接受机器人或腹腔镜减重手术的所有患者的数据。我们使用自下而上的方法检索人口统计学、临床特征、术后数据和成本。主要终点是机器人和腹腔镜组的医院费用。使用倾向评分匹配分析数据。
在纳入研究的 122 名患者中，有 42 名随后根据倾向评分选择，每组 21 名。两组的临床特征和术后结果无差异。住院时间为 2.4±0.7 天 vs. 2.6±1.1 天（p=0.520）。在机器人和腹腔镜组中，总费用分别为 16275 美元±4018 美元和 12690 美元±2834 美元（绝对差值为 3585 美元，95%CI 1416-5753 美元，p=0.002），直接费用分别为 5037 美元±1282 美元和 3720 美元±1308 美元（绝对差值为 1316 美元，95%CI 509-2214 美元，p=0.002），间接费用分别为 11238 美元±3234 美元和 8970 美元±3021 美元（绝对差值为 2268 美元，95%CI 317-4220 美元，p=0.024）。亚组分析显示，初次胃旁路手术和再次手术患者的成本差异呈下降趋势。
与腹腔镜相比，使用机器人系统手术的患者的总住院费用更高，但目前尚未显示出临床优势。亚组分析显示，再次减重手术患者的成本差异较小，机器人手术可能更有价值。
