背景:作为一种微创技术,与开放手术相比,机器人辅助子宫切除术(RAH)具有手术优势,且发病率显著降低.尽管RAH在良性妇科中的使用越来越多,关于其成本效益的数据有限,尤其是在欧洲背景下。我们的目标是评估不同子宫切除术的成本,来描述他们的临床结果,评估RAH对不同类型子宫切除术率的影响。
方法:对良性适应症行子宫切除术的患者进行回顾性单中心成本分析。腹部子宫切除术(AH),阴式子宫切除术(VH),腹腔镜子宫切除术(LH),包括腹腔镜辅助阴式子宫切除术(LAVH)和RAH。我们使用“活动中心护理计划模型”考虑了不同子宫切除术技术的手术室和住院费用。我们报告了不同方法的术中和术后并发症及其成本关系。
结果:在2014年1月至2021年12月之间,830例患者接受了手术;67例接受了VH(8%),108LAVH(13%),351LH(42%),148RAH(18%)和156AH(19%)。在2018年实施RAH专用计划和学习曲线后,AH从2014-2017年的27.3%下降到2018年的22.1%和2019-2021年的6.9%。所有手术技术的再干预率为3-4%。AH后进行药物干预和输血的比例为28%,在其他方法的17-22%中。AH的住院费用最高,平均为2236.40欧元。微创技术的平均住院费用为1136.77-1560.66欧元。RAH的平均总成本为6528.10欧元,而AH的平均总成本为4400.95欧元。
结论:实施RAH导致开放手术率大幅下降。然而,RAH仍然是我们队列中最昂贵的技术,主要是由于材料和折旧成本较高。因此,不应该为每个患者考虑RAH,但是对于那些需要更多侵入性手术的人来说,并发症的风险更高。未来的前瞻性研究应关注社会成本和患者报告的结果,为了进行成本效益分析,并进一步评估RAH在当前医疗保健环境中的确切价值。
BACKGROUND: As a minimally invasive technique, robot-assisted
hysterectomy (RAH) offers surgical advantages and significant reduction in morbidity compared to open surgery. Despite the increasing use of RAH in benign gynaecology, there is limited data on its cost-effectiveness, especially in a European context. Our goal is to assess the costs of the different
hysterectomy approaches, to describe their clinical outcomes, and to evaluate the impact of introduction of RAH on the rates of different types of hysterectomy.
METHODS: A retrospective single-centre cost-analysis was performed for patients undergoing a hysterectomy for benign indications. Abdominal
hysterectomy (AH), vaginal
hysterectomy (VH), laparoscopic
hysterectomy (LH), laparoscopically assisted vaginal
hysterectomy (LAVH) and RAH were included. We considered the costs of operating room and hospital stay for the different
hysterectomy techniques using the \"Activity Centre-Care program model\". We report on intra- and postoperative complications for the different approaches as well as their cost relationship.
RESULTS: Between January 2014 and December 2021, 830 patients were operated; 67 underwent VH (8%), 108 LAVH (13%), 351 LH (42%), 148 RAH (18%) and 156 AH (19%). After the implementation and learning curve of a dedicated program for RAH in 2018, AH declined from 27.3% in 2014-2017, to 22.1% in 2018 and 6.9 % in 2019-2021. The reintervention rate was 3-4% for all surgical techniques. Pharmacological interventions and blood transfusions were performed after AH in 28%, and in 17-22% of the other approaches. AH had the highest hospital stay cost with an average of €2236.40. Mean cost of the hospital stay ranged from €1136.77-€1560.66 for minimally invasive techniques. The average total costs for RAH were €6528.10 compared to €4400.95 for AH.
CONCLUSIONS: Implementation of RAH resulted in a substantial decrease of open surgery rate. However, RAH remains the most expensive technique in our cohort, mainly due to high material and depreciation costs. Therefore, RAH should not be considered for every patient, but for those who would otherwise need more invasive surgery, with higher risk of complications. Future prospective studies should focus on the societal costs and patient reported outcomes, in order to do cost-benefit analysis and further evaluate the exact value of RAH in the current healthcare setting.