Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia.
Ann Surg Oncol. 2024 Dec;31(13):9079-9087. doi: 10.1245/s10434-024-16227-3. Epub 2024 Sep 16.
Pelvic exenteration (PE) is a radical procedure involving multi-visceral resection for locally advanced pelvic malignancies. Such radical surgery is associated with prolonged operating theater time and hospital stay, as well as a substantial risk of postoperative complications, and therefore significant financial cost. This study aimed to comprehensively detail the inpatient cost of PE at a specialist center in the Australian public sector.
A retrospective costing review of consecutive PE operations at Royal Prince Alfred Hospital in Sydney between March 2014 and June 2022 was performed. Clinical data were extracted from a prospectively maintained database, and in-hospital costing data were provided by the hospital Performance Unit. All statistical analyses were performed using SPSS.
Pelvic exenteration was performed for 461 patients, of whom 283 (61 %) had primary or recurrent rectal cancer, 160 (35 %) had primary or recurrent non-rectal cancer, and 18 (4 %) had a benign indication. The median admission cost was $108,259.4 ($86,620.8-$144,429.3) (Australian dollars [AUD]), with the highest costs for staffing followed by the operating room. Overall, admission costs were higher for complete PE (p < 0.001), PE combined with cytoreductive surgery (CRS) (p < 0.001), and older patients (p = 0.006).
The total admission cost for patients undergoing PE reflects the complexity of the procedure and the multidisciplinary requirement. Patients of advanced age undergoing complete PE and PE combined with CRS incurred greater costs, but the requirement of a sacrectomy, vertical rectus abdominal flap reconstruction, major nerve or vascular excision, or repair were not associated with higher overall cost in the multivariate analysis.
盆腔廓清术（PE）是一种涉及多脏器切除的根治性手术，适用于局部晚期盆腔恶性肿瘤。这种根治性手术与手术时间延长、住院时间延长以及术后并发症的高风险相关，因此会产生巨大的经济成本。本研究旨在全面详细描述澳大利亚公立部门一家专科中心的盆腔廓清术住院费用。
对 2014 年 3 月至 2022 年 6 月在悉尼皇家阿尔弗雷德王子医院连续进行的盆腔廓清术进行回顾性成本回顾。临床数据从一个前瞻性维护的数据库中提取，住院成本数据由医院绩效部门提供。所有统计分析均使用 SPSS 进行。
为 461 名患者实施了盆腔廓清术，其中 283 名（61%）患有原发性或复发性直肠肿瘤，160 名（35%）患有原发性或复发性非直肠肿瘤，18 名（4%）有良性指征。中位入院费用为 108259.4 澳元（86620.8-144429.3），其中人员配备成本最高，其次是手术室。总的来说，完全盆腔廓清术（p < 0.001）、盆腔廓清术联合细胞减灭术（CRS）（p < 0.001）和老年患者（p = 0.006）的入院费用更高。
接受盆腔廓清术的患者的总入院费用反映了手术的复杂性和多学科需求。年龄较大的完全盆腔廓清术和盆腔廓清术联合 CRS 患者的费用更高，但在多变量分析中，行根治性切除术、垂直腹直肌皮瓣重建、重要神经或血管切除或修复并不与总费用增加相关。
