Cost comparison of robotic-assisted laparoscopic hysterectomy versus standard laparoscopic hysterectomy.
Cost comparison of robotic-assisted laparoscopic hysterectomy versus standard laparoscopic hysterectomy.
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DOI：
10.1007/s11701-015-0526-z
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发表时间：
2015-12
影响因子：
2.3
通讯作者：
Bustillo G
中科院分区：
文献类型：
--
作者：
Winter ML;Leu SY;Lagrew DC Jr;Bustillo G
该研究的目的是评估机器人辅助全腹腔镜子宫切除术的成本是否与外科医生在最初的学习曲线之后进行的标准腹腔镜子宫切除术的成本相似。对2013年1月1日至2013年9月30日期间在橙子海岸纪念医学中心（OCMMC）和马鞍峰纪念医学中心进行的所有良性适应症（无伴随重大手术）的直肠切除术进行了回顾性病历审查。比较了机器人辅助全腹腔镜直肠癌切除术（RTLH）和标准腹腔镜直肠癌切除术（LAVH和TLH）。分析的数据仅包括那些由外科医生进行的超过其初始学习曲线的直肠切除术（至少30个以前的机器人病例）。主要结局是患者与子宫切除术相关的直接住院总费用。次要结局为估计失血量、手术时间和术后住院天数。应用多元线性回归模型评价RTLH和LAVH/TLH在住院费用、失血量和手术时间方面的差异，同时调整医院、患者年龄、体重指数（BMI）、患者既往是否接受过腹部/盆腔手术和子宫重量。采用χ2检验分析住院时间与手术类型之间的关系。在OCMMC进行了93例阑尾切除术（5例LAVH，88例RTLH），在鞍背纪念医学中心进行了90例阑尾切除术（6例LAVH，17例TLH，67例RTLH）。住院总费用结果显示，在调整医院、年龄、BMI、既往腹部/盆腔手术和子宫重量后，RTLH并不显著高于LAVH/TLH（平均差异）。= $283.1，95%CI = [-569.6，1135.9]; p = 0.51）。然而，OCMMC的成本显着高于马鞍峰纪念医疗中心（平均差异。= $2008.7，95%CI = [1380.6，2636.7]; p < 0.0001）;成本随子宫重量显著增加（β = 3.8，95%CI = [2.3，5.3]; p < 0.0001）。进一步分析显示失血量显著减少（平均差异）。= −78.5 ml，95% CI = [−116.8，−40.3]; p < 0.0001）和更短的手术时间（平均差异=-21.9分钟，RTLH与LAVH/TLH的95% CI = [−39.6，−4.2]; p = 0.016）。住院时间与手术类型之间无显著相关性（p = 0.43）。在调整患者水平的协变量后，在两个社区医院，当外科医生通过他们的初始学习曲线进行手术时，机器人辅助腹腔镜子宫切除术与标准腹腔镜子宫切除术的成本没有统计学显著差异。
The aim of the study was to assess if the cost of robotic-assisted total laparoscopic hysterectomy is similar to the cost of standard laparoscopic hysterectomy when performed by surgeons past their initial learning curve. A retrospective chart review of all hysterectomies was performed for benign indications without concomitant major procedures at Orange Coast Memorial Medical Center (OCMMC) and Saddleback Memorial Medical Center between January 1, 2013 and September 30, 2013. Robotic-assisted total laparoscopic hysterectomies (RTLH) and standard laparoscopic hysterectomies (LAVH and TLH) were compared. Data analyzed included only those hysterectomies performed by surgeons past their initial learning curve (minimum of 30 previous robotic cases). The primary outcome was the direct total cost of patient’s hospitalization related to hysterectomy. The secondary outcomes were estimated blood loss, surgery time, and days in hospital post-surgery. A multiple linear regression model was applied to evaluate the difference between RTLH and LAVH/TLH in hospital cost, blood loss, and surgery time, while adjusting for hospital, patient’s age, body mass index (BMI), whether or not the patient had previous abdominal/pelvic surgery, and uterine weight. The χ2 test was applied to examine the association between hospital stay and surgery type. There were 93 hysterectomies (5 LAVH, 88 RTLH) performed at OCMMC and 90 hysterectomies (6 LAVH, 17 TLH, 67 RTLH) performed at Saddle-back Memorial Medical Center. The hospitalization total cost result showed that, after adjusting for hospital, age, BMI, previous abdominal/pelvic surgery, and uterine weight, RTLH was not significantly more expensive than LAVH/TLH (mean diff. = $283.1, 95 % CI = [−569.6, 1135.9]; p = 0.51) at the 2 study hospitals. However, the cost at OCMMC was significantly higher than Saddleback Memorial Medical Center (mean diff. = $2008.7, 95 % CI = [1380.6, 2636.7]; p < 0.0001); and the cost increased significantly with uterine weight (β = 3.8, 95 % CI = [2.3, 5.3]; p < 0.0001). Further analysis showed significantly less blood loss (mean diff. = −78.5 ml, 95 % CI = [−116.8, −40.3]; p < 0.0001) and shorter surgery time (mean diff. = −21.9 min., 95 % CI = [−39.6, −4.2]; p = 0.016) for RTLH versus LAVH/TLH. There was no significant association between hospital stay and surgery type (p = 0.43). After adjusting for patient-level covariates, there was no statistically significant cost difference of performing robotically assisted laparoscopic hysterectomy versus standard laparoscopic hysterectomy when performed by surgeons past their initial learning curve at two community hospitals.