PDF(Pubmed)
Abstract：
Most studies comparing surgical platforms focus on short-term outcomes. In this study, we compare the expanding societal penetration of minimally invasive surgery (MIS) with open colectomy by assessing payer and patient expenditures up to one year for patients undergoing surgery for colon cancer.
We analyzed the IBM MarketScan Database for patients who underwent left or right colectomy for colon cancer between 2013 and 2020. Outcomes included perioperative complications and total health-care expenditures up to 1 year following colectomy. We compared results for patients who had open colectomy (OS) to those with MIS operations. Subgroup analyses were performed for adjuvant chemotherapy (AC+) versus no adjuvant chemotherapy (AC-) groups and for laparoscopic (LS) versus robotic (RS) approaches.
Of 7,063 patients, 4,417 cases did not receive adjuvant chemotherapy (OS: 20.1%, LS: 67.1%, RS: 12.7%) and 2646 cases had adjuvant chemotherapy (OS: 28.4%, LS: 58.7%, RS: 12.9%) after discharge. MIS colectomy was associated with lower mean expenditure at index surgery and post-discharge periods for AC- patients (index surgery: $34,588 vs $36,975; 365-day post-discharge $20,051 vs $24,309) and for AC+ patients (index surgery: $37,884 vs $42,160; 365-day post-discharge $103,341vs $135,113; p < 0.001 for all comparisons). LS had similar index surgery expenditures but significantly higher expenditures at post-discharge 30 days (AC-: $2,834 vs $2276, p = 0.005; AC+: $9100 vs $7698, p = 0.020) than RS. The overall complication rate was significantly lower in the MIS group than the open group for AC- patients (20.5% vs 31.2%) and AC+ patients (22.6% vs 39.1%, both p < 0.001).
MIS colectomy is associated with better value at lower expenditure than open colectomy for colon cancer at the index operation and up to one year after surgery. RS expenditure is less than LS in the first 30 postoperative days regardless of chemotherapy status and may extend to 1 year for AC- patients.
We analyzed the IBM MarketScan Database for patients who underwent left or right colectomy for colon cancer between 2013 and 2020. Outcomes included perioperative complications and total health-care expenditures up to 1 year following colectomy. We compared results for patients who had open colectomy (OS) to those with MIS operations. Subgroup analyses were performed for adjuvant chemotherapy (AC+) versus no adjuvant chemotherapy (AC-) groups and for laparoscopic (LS) versus robotic (RS) approaches.
Of 7,063 patients, 4,417 cases did not receive adjuvant chemotherapy (OS: 20.1%, LS: 67.1%, RS: 12.7%) and 2646 cases had adjuvant chemotherapy (OS: 28.4%, LS: 58.7%, RS: 12.9%) after discharge. MIS colectomy was associated with lower mean expenditure at index surgery and post-discharge periods for AC- patients (index surgery: $34,588 vs $36,975; 365-day post-discharge $20,051 vs $24,309) and for AC+ patients (index surgery: $37,884 vs $42,160; 365-day post-discharge $103,341vs $135,113; p < 0.001 for all comparisons). LS had similar index surgery expenditures but significantly higher expenditures at post-discharge 30 days (AC-: $2,834 vs $2276, p = 0.005; AC+: $9100 vs $7698, p = 0.020) than RS. The overall complication rate was significantly lower in the MIS group than the open group for AC- patients (20.5% vs 31.2%) and AC+ patients (22.6% vs 39.1%, both p < 0.001).
MIS colectomy is associated with better value at lower expenditure than open colectomy for colon cancer at the index operation and up to one year after surgery. RS expenditure is less than LS in the first 30 postoperative days regardless of chemotherapy status and may extend to 1 year for AC- patients.
摘要：
背景：大多数比较手术平台的研究集中在短期结果。在这项研究中,我们比较了微创手术(MIS)和开放式结肠切除术的不断扩大的社会渗透,评估了结肠癌手术患者长达1年的付款人和患者支出.
方法：我们分析了IBMMarketScan数据库在2013年至2020年间接受左或右结肠切除术治疗结肠癌的患者。结果包括围手术期并发症和结肠切除术后1年的总医疗保健支出。我们比较了进行开放式结肠切除术（OS）的患者与进行MIS手术的患者的结果。对辅助化疗（AC）与无辅助化疗（AC-）组以及腹腔镜（LS）与机器人（RS）方法进行了亚组分析。
结果：在7,063名患者中，4,417例未接受辅助化疗（OS：20.1%，LS：67.1%，RS：12.7%）和2646例辅助化疗（OS：28.4%，LS：58.7%，RS：12.9%）出院后。对于AC患者（指数手术：$34,588vs$36,975；出院后365天$20,051vs$24,309）和AC患者（指数手术：$37,884vs$42,160；出院后365天$103,341vs$135,113；所有比较p<0.001），在指数手术和出院期间，MIS结肠切除术的平均支出较低。LS具有相似的指数手术支出，但在出院后30天的支出（AC-：$2,834vs$2276，p=0.005；AC：$9100vs$7698，p=0.020）明显高于RS。MIS组的总体并发症发生率显着低于开放组的AC患者（20.5％vs31.2％）和AC患者（22.6％vs39.1％，两者p<0.001)。
结论：在初次手术和手术后一年内，MIS结肠切除术在较低的支出下比开腹结肠切除术具有更好的价值。无论化疗状态如何，术后前30天的RS支出均小于LS，并且对于AC患者可能会延长至1年。
方法：我们分析了IBMMarketScan数据库在2013年至2020年间接受左或右结肠切除术治疗结肠癌的患者。结果包括围手术期并发症和结肠切除术后1年的总医疗保健支出。我们比较了进行开放式结肠切除术（OS）的患者与进行MIS手术的患者的结果。对辅助化疗（AC）与无辅助化疗（AC-）组以及腹腔镜（LS）与机器人（RS）方法进行了亚组分析。
结果：在7,063名患者中，4,417例未接受辅助化疗（OS：20.1%，LS：67.1%，RS：12.7%）和2646例辅助化疗（OS：28.4%，LS：58.7%，RS：12.9%）出院后。对于AC患者（指数手术：$34,588vs$36,975；出院后365天$20,051vs$24,309）和AC患者（指数手术：$37,884vs$42,160；出院后365天$103,341vs$135,113；所有比较p<0.001），在指数手术和出院期间，MIS结肠切除术的平均支出较低。LS具有相似的指数手术支出，但在出院后30天的支出（AC-：$2,834vs$2276，p=0.005；AC：$9100vs$7698，p=0.020）明显高于RS。MIS组的总体并发症发生率显着低于开放组的AC患者（20.5％vs31.2％）和AC患者（22.6％vs39.1％，两者p<0.001)。
结论：在初次手术和手术后一年内，MIS结肠切除术在较低的支出下比开腹结肠切除术具有更好的价值。无论化疗状态如何，术后前30天的RS支出均小于LS，并且对于AC患者可能会延长至1年。
