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首页> 外文期刊>Surgical Endoscopy >Cost analysis of open and laparoscopic pancreaticoduodenectomy: A single institution comparison
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Cost analysis of open and laparoscopic pancreaticoduodenectomy: A single institution comparison

机译：开放式和腹腔镜胰十二指肠切除术的成本分析：单个机构的比较

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Introduction: The laparoscopic approach to pancreaticoduodenectomy has been recently more frequently reported and is now being performed at multiple centers across the US. While laparoscopic pancreaticoduodenectomy (LPD) has been shown to be safe and feasible, comparing its cost in relation to open pancreaticoduodenectomy (OPD) has not been examined. The aim of this study is to examine the cost of LPD compared with OPD at a single institution over a 3-year time period. Methods: An institutional database was analyzed to compare patients who underwent OPD and LPD (including Whipple resections and total pancreatectomy) between May 2009 and June 2012. A cost analysis was performed, which included the use the hospital billing database to assess surgical costs, hospital admission costs, and overall cost of the patient's care during the index admission. The operative costs were further analyzed with respect to OR time and surgical supplies. Standard statistical analysis was performed to assess for significance. Results: In the study time period, 123 patients underwent pancreaticoduodenectomy, including 48 OPD (39 %) and 75 LPD (61 %). The groups were similar with respect to age, gender, ASA, vein resection, and indication for surgery. In the LPD group, the use of hand assist or conversion to OPD occurred in 3 (4 %) and 10 (13 %) patients, respectively. Additionally, 10 % of the OPD group underwent total pancreatectomy (n = 5), compared to 21 % of the LPD (n = 16). Mean operative time for OPD and LPD was 355 min (range 199-681) and 551 min (range 390-819) respectively (p < 0.0001). Median hospital stay for OPD and LPD was 8 days (range 5-63), and 7 days (range 4-68) respectively (p = 0.5). Morbidity rates were equal at 31 % for the two groups. The LPD group was associated with significantly higher surgical cost due to both increased time and supply cost. However, mean hospital admission cost associated with OPD was greater in comparison to the LPD group, though not significant. The overall total cost of care was similar between the two groups. Conclusions: LPD is associated with equivalent overall cost compared with OPD. While operating time and supply costs were higher for LPD, this was balanced by decreased cost of the postoperative admission.
机译：简介：腹腔镜胰十二指肠切除术的方法最近得到了越来越多的报道，现在在美国的多个中心进行。虽然腹腔镜胰十二指肠切除术（LPD）已被证明是安全可行的，但尚未检查与开腹胰十二指肠切除术（OPD）进行比较的费用。这项研究的目的是在3年的时间内检查单个机构中LPD与OPD相比的成本。方法：分析机构数据库以比较2009年5月至2012年6月间接受OPD和LPD（包括Whipple切除术和全胰腺切除术）的患者。进行了成本分析，包括使用医院计费数据库评估手术费用，入院费用，以及指数入院期间患者护理的总体费用。进一步分析了手术时间和手术供应方面的手术费用。进行标准统计分析以评估重要性。结果：在研究期间，有123例患者接受了胰十二指肠切除术，包括48例OPD（39％）和75例LPD（61％）。各组在年龄，性别，ASA，静脉切除和手术适应证方面相似。在LPD组中，分别有3（4％）和10（13％）患者使用了手助或转换为OPD。此外，OPD组有10％接受了全胰腺切除术（n = 5），而LPD组只有21％（n = 16）。 OPD和LPD的平均手术时间分别为355分钟（范围199-681）和551分钟（范围390-819）（p <0.0001）。 OPD和LPD的中位住院时间分别为8天（范围5-63）和7天（范围4-68）（p = 0.5）。两组的发病率相等于31％。 LPD组由于时间和供应成本的增加而明显增加了手术费用。然而，与LPD组相比，与OPD相关的平均入院费用更高，尽管并不显着。两组的总护理总费用相似。结论：与OPD相比，LPD与总成本相当。虽然LPD的手术时间和供应成本较高，但可以通过减少术后入院成本来平衡。

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