腹腔镜与机器人辅助胰体尾切除术的术后结果和费用：倾向评分匹配分析。
Postoperative outcomes and costs of laparoscopic versus robotic distal pancreatectomy: a propensity-matched analysis.
机构信息
Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Stanford Prevention Research Center and Departments of Statistics and Health Research and Policy, Stanford University, Stanford, CA, USA.
出版信息
Surg Endosc. 2024 Apr;38(4):2095-2105. doi: 10.1007/s00464-024-10728-8. Epub 2024 Mar 4.
BACKGROUND
Minimally invasive distal pancreatectomy (MIDP) has established advantages over the open approach. The costs associated with robotic DP (RDP) versus laparoscopic DP (LDP) make the robotic approach controversial. We sought to compare outcomes and cost of LDP and RDP using propensity matching analysis at our institution.
METHODS
Patients undergoing LDP or RDP between 2000 and 2021 were retrospectively identified. Patients were optimally matched using age, gender, American Society of Anesthesiologists status, body mass index, and tumor size. Between-group differences were analyzed using the Wilcoxon signed-rank test for continuous data, and the McNemar's test for categorical data. Outcomes included operative duration, conversion to open surgery, postoperative length of stay, pancreatic fistula rate, pseudocyst requiring intervention, and costs.
RESULTS
298 patients underwent MIDP, 180 (60%) were laparoscopic and 118 (40%) were robotic. All RDPs were matched 1:1 to a laparoscopic case with absolute standardized mean differences for all matching covariates below 0.10, except for tumor type (0.16). RDP had longer operative times (268 vs 178 min, p < 0.01), shorter length of stay (2 vs 4 days, p < 0.01), fewer biochemical pancreatic leaks (11.9% vs 34.7%, p < 0.01), and fewer interventional radiological drainage (0% vs 5.9%, p = 0.01). The number of pancreatic fistulas (11.9% vs 5.1%, p = 0.12), collections requiring antibiotics or intervention (11.9% vs 5.1%, p = 0.12), and conversion rates (3.4% vs 5.1%, p = 0.72) were comparable between the two groups. The total direct index admission costs for RDP were 1.01 times higher than for LDP for FY16-19 (p = 0.372), and 1.33 times higher for FY20-22 (p = 0.031).
CONCLUSIONS
Although RDP required longer operative times than LDP, postoperative stays were shorter. The procedure cost of RDP was modestly more expensive than LDP, though this was partially offset by reduced hospital stay and reintervention rate.
背景
微创远端胰腺切除术（MIDP）在开放性手术方面具有明显优势。机器人辅助 DP（RDP）与腹腔镜 DP（LDP）的相关成本使得机器人手术方法具有争议性。我们旨在使用我们机构的倾向匹配分析来比较 LDP 和 RDP 的结果和成本。
方法
回顾性确定了 2000 年至 2021 年间接受 LDP 或 RDP 的患者。通过年龄、性别、美国麻醉医师协会状态、体重指数和肿瘤大小，对患者进行最佳匹配。使用 Wilcoxon 符号秩检验对连续数据进行组间差异分析，使用 McNemar 检验对分类数据进行分析。结果包括手术时间、转为开放性手术、术后住院时间、胰瘘发生率、需要干预的假性囊肿和成本。
结果
298 例患者接受了 MIDP，其中 180 例（60%）为腹腔镜手术，118 例（40%）为机器人手术。所有 RDP 均与腹腔镜病例 1:1 匹配，所有匹配协变量的绝对标准化平均差异均低于 0.10，除肿瘤类型（0.16）外。RDP 的手术时间更长（268 分钟比 178 分钟，p<0.01），住院时间更短（2 天比 4 天，p<0.01），生化性胰漏发生率更低（11.9%比 34.7%，p<0.01），放射介入引流术更少（0%比 5.9%，p=0.01）。两组之间胰瘘发生率（11.9%比 5.1%，p=0.12）、需要抗生素或干预的集液发生率（11.9%比 5.1%，p=0.12）和转化率（3.4%比 5.1%，p=0.72）相当。RDP 的直接索引入院总成本在 FY16-19 期间比 LDP 高 1.01 倍（p=0.372），在 FY20-22 期间高 1.33 倍（p=0.031）。
结论
尽管 RDP 的手术时间比 LDP 长，但术后住院时间更短。RDP 的手术费用略高于 LDP，但这部分被住院时间缩短和再干预率降低所抵消。
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