The impact of surgeon choices on costs associated with uncomplicated minimally invasive colectomy:you are not as important as you think  

外科医生对微创结肠切除手术医疗费用的影响:你并没有您想像中的那么重要

作　　者：John Tillou Deborah Nagle Vitaliy Poylin Thomas Cataldo 

机构地区：[1]Division of Colon and Rectal Surgery,Department of Surgery,Beth Israel Deaconess Medical Center,Boston,MA,USA

出　　处：《Gastroenterology Report》2018年第2期108-113,I0002,共7页胃肠病学报道（英文）

摘　　要：Background:There is increasing public discussion about the escalating cost of healthcare in America.There are no published data regarding the contribution of individual surgeons’choices on the cost of uncomplicated minimally invasive colectomy.Methods:A review of a hospital cost-accounting database of the direct costs related to the index operation and postoperative care of all patients who underwent elective minimally invasive segmental colectomy over a 1-year period was performed.Results:A total of 111 cases were enrolled in this study,18 of which were performed robotically.The average direct cost after minimally invasive colectomy was$5536.The cost of robotic colectomy was 53%greater than laparoscopic($7806 vs$5096,p<0.001).There was no statistically significant difference in overall costs among laparoscopic cases performed by three surgeons($5099 vs$5108 vs$5055,p¼0.987).Average operating room supply costs among the three surgeons were$1236,$1105 and$1030,respectively(p¼0.067),with a standard deviation of$328(6.4%of overall cost).Conclusions:No significant difference in overall costs between surgeons was demonstrated despite varied training,experience levels and operative techniques.Total costs are relatively institutionally fixed and minimally influenced by variations in individual surgeon preferences.背景:在美国,民众对持续增长的医疗费用的关注度越来越高。对于简单的微创结肠切除手术(结肠肠段切除术且术后未出现重要并发症)的治疗费用,外科医生本身是否会产生影响目前尚无数据报道。方法:分析我院医疗成本数据库中近一年来行择期微创结肠肠段切除手术患者的手术及术后治疗相关的直接医疗费用。结果:共计111例患者纳入研究,其中18例行机器人手术。微创结肠切除手术的平均直接费用是5536美元,机器人手术比腹腔镜手术高53%(7806美元vs.5096美元,P<0.001)。3名外科医生所施行的腹腔镜手术,其总体医疗费用分别为5099美元、5108美元和5055美元(P¼0.987);其中,手术室费用分别是1236美元、1105美元和1030美元(P¼0.067),标准差为328美元(占总费用的6.4%)。结论:对于微创结肠切除手术患者,就治于不同外科医生所产生的总体医疗费用并无显著差异,无论外科医生资历高低、经验水平和手术技术。总体医疗费用在同一机构是相对固定的,外科医生个体对其影响甚微。

关 键 词：cost minimally invasive colectomy laparoscopy individual surgeon 

分 类 号：R73[医药卫生—肿瘤]