Comprehensive comparative analysis of cost-effectiveness and perioperative outcomes between open, laparoscopic, and robotic distal pancreatectomy
| Autor: | Deepa Magge, Amer H. Zureikat, Ahmad Hamad, Mazen S. Zenati, Herbert J. Zeh, Melissa E. Hogg, Caroline J. Rieser |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Comparative Effectiveness Research medicine.medical_specialty Time Factors Databases Factual Cost effectiveness Cost-Benefit Analysis Operative Time Comparative effectiveness research 030230 surgery 03 medical and health sciences Pancreatectomy Postoperative Complications 0302 clinical medicine Robotic Surgical Procedures Cost Savings Operating time Humans Medicine In patient Hospital Costs Aged Retrospective Studies Hepatology business.industry Gastroenterology Retrospective cohort study Perioperative Length of Stay Middle Aged Conversion to Open Surgery Surgery Treatment Outcome 030220 oncology & carcinogenesis Cohort Female Laparoscopy Distal pancreatectomy business |
| Zdroj: | HPB. 20:1172-1180 |
| ISSN: | 1365-182X |
| Popis: | NSQIP data show that half of distal pancreatectomies (DP) are performed by a minimally invasive approach (MIS). Advantages have been demonstrated for MIS DP, yet comparative cost data are limited. Outcomes and cost were compared in patients undergoing open (ODP), laparoscopic (LDP), and robotic (RDP) approaches at a single institution.A retrospective review was performed on patients undergoing DP between 1/2010-5/2016. Analysis was intention-to-treat, and cost was available after 1/2013.DP was performed in 374 patients: ODP = 85, LDP = 93, and RDP = 196. Operating time was lowest in the RDP cohort (p 0.0001). ODP had higher estimated blood loss (p 0.0001) and transfusions (p 0.0001) than LDP and RDP. LDP had greater conversions to open procedures than RDP (p = 0.001). Postoperative outcomes were similar between groups. Length of stay was higher in the ODP group (p = 0.0001) than LDP and RDP. Overall cost for the ODP was higher than the RDP and LDP group (p = 0.002). On multivariate analysis, RDP reduced LOS (ODP: Odds = 6.5 [p = 0.0001] and LDP: Odds = 2.1 [p = 0.036]) and total cost (ODP: Odds = 5.7 [p = 0.002] and LDP: Odds = 2.8 [p = 0.042]) independently of all demographics and illness covariates.A robotic approach is associated with reduced length of stay and cost compared to open and laparoscopic procedures. |
| Databáze: | OpenAIRE |
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