Cost comparison of robotic-assisted laparoscopic hysterectomy versus standard laparoscopic hysterectomy

被引：16
作者：
Winter M.L. [1 ]
Leu S.-Y. [2 ,3 ]
Lagrew D.C. [4 ]
Jr. [4 ]
Bustillo G. [5 ]
机构：
[1] Saddleback Memorial Medical Center, 24411 Health Center Drive, Suite 200, Laguna Hills, 92653, CA
[2] Department of Pediatrics, School of Medicine, University of California, Irvine
[3] Biostatistics, Epidemiology and Research Design Unit, UCI Institute for Clinical and Translational Science, University of California, Irvine
[4] MemorialCare Health System, Fountain Valley, CA
[5] Orange Coast Memorial Medical Center, Fountain Valley, CA
来源：
Journal of Robotic Surgery | 2015年 / 9卷 / 4期
基金：
美国国家卫生研究院;
关键词：
Cost; Hysterectomy; Robotic;
D O I：
10.1007/s11701-015-0526-z
中图分类号：
学科分类号：
摘要：
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 Saddleback 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. © 2015, Springer-Verlag London.
引用
收藏
页码：269 / 275
页数：6
相关论文
共 20 条
  • [1] Sample N.I., Healthcare Cost and Utilization Project, (2014)
  • [2] Wright J.D., Anath C.V., Lewin S.N., Burke W.M., Lu Y.S., Negut A.I., Et al., Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease, JAMA, 309, pp. 689-698, (2013)
  • [3] Paraiso M.F., Ridgeway B., Park A.J., Jelorsek J.E., Barber M.D., Falcone T., Et al., A randomized trial comparing conventional and robotically assisted total laparoscopic hysterectomy, Am J Obstet Gynecol, 208, pp. 1-7, (2013)
  • [4] Rosero E.B., Kho K.A., Joshi G.P., Giesecke M., Schaffer J.I., Comparison of robotic and laparoscopic hysterectomy for benign gynecologic disease, Obstet Gyencol, 122, pp. 778-786, (2013)
  • [5] Sarlos D., Kots L., Stevanovic N., Schaer G., Robotic compared with conventional laparoscopic hysterectomy: a randomized controlled trial, Obstet Gyencol, 120, pp. 604-611, (2012)
  • [6] Sarlos G., Kots L., Stevanovic N., Schar G., Robotic hysterectomy versus conventional laparoscopic hysterectomy: outcome and cost analyses of a matched case–control study, Eur J Obstet Gynecol Reprod Biol, 150, pp. 92-96, (2010)
  • [7] Liu H., Lu D., Wang L., Shi G., Song H., Clarke J., Robotic surgery for benign gynecological disease. Cochrane Database Syst Rev, (2), Art. No.: CD, 8978, (2012)
  • [8] Sarlos D., Kots L.A., Robotic versus laparoscopic hysterectomy: a review of recent comparative studies, Curr opin Obstet Gyencol, 23, pp. 283-288, (2011)
  • [9] Paraiso M.F., Jelovek J.E., Frick A., Chen C.C., Barber M.D., Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial, Obstet Gynecol, 118, pp. 1005-1013, (2011)
  • [10] Wright K.N., Jonsdottir G.M., Jorgensen S., Shah N., Einarsson J.I., Costs and outcomes of abdominal, vaginal, laparoscopic and robotic hysterectomies, JSLS, 16, pp. 519-524, (2012)
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