Annals of surgery · 2025
Cost-analysis of Implementing Robot-assisted Versus Open Pancreatoduodenectomy.
СтатьяСравнительное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Menso Julia E, Francken Michiel F G, de Graaf Nine, Bonomi Alessandro M, Guastella Riccardo, Balaban Dylan, Ali Mahsoem, Bonjer Jaap, van Dieren Susan, Dijkgraaf Marcel G W, van Hilst Jony, Pilz da Cunha Gabriela, Erdmann Joris, Kazemier Geert, Swijnenburg Rutger-Jan, Zonderhuis Barbara M, Daams Freek, Festen Sebastiaan, Busch Olivier R, Besselink Marc G, for HPB-Amsterdam
Аннотация
OBJECTIVE: To perform a cost analysis during the implementation of robot-assisted pancreatoduodenectomy (RPD) in a high-volume center.
BACKGROUND: Many high-volume centers are implementing RPD as an alternative to open pancreatoduodenectomy (OPD) but the persevering concerns about increased costs of RPD versus OPD have not been addressed by large studies.
METHODS: Post hoc cost analysis of consecutive RPD versus OPD in a singly high-volume center (January 2015-June 2024). The eligibility criteria for RPD (ie, no vascular contact, no chronic and necrotizing pancreatitis, and body mass index <35 kg/m 2 ) were used to select patients undergoing OPD to minimize selection bias. Primary outcomes were total hospital costs and total hospital stay. Sensitivity analyses excluded the first half of the RPD experience.
RESULTS: Overall, 588 patients undergoing pancreatoduodenectomy were included (214 RPDs, 374 OPDs). Total hospital stay was shorter after RPD [10 days (6 to 17) vs 12 (8 to 21), P = 0.001]. Mean total hospital costs were €4804 higher for RPD (€27,307 vs €22,503, P = 0.010). Outcomes improved in the second half of the RPD experience (n = 107): total hospital stay [12 days (7 to 23) to 9 (6 to 15), P < 0.001], pancreatic fistula (48.6% to 31.8%, P = 0.012), delayed gastric emptying (33.6% to 15.0%, P = 0.001), and operative time [373 minutes (341 to 411) to 310 (272 to 352), P <0.001]. Consequently, costs per RPD procedure decreased by €11,058 (€32,836 to €21,778, P = 0.001). Costs in the second half of the OPD experience remained stable (€24,025 to €21,013, P = 0.210). Hence, total hospital costs for RPD and OPD became comparable in the second half (€21,778 vs €21,013, P = 0.644).
CONCLUSIONS: Implementing RPD is associated with considerable additional costs compared with OPD. With growing experience, both the outcomes and cost-efficiency of RPD improve, with costs decreasing by approximately a third, leading to similar costs as OPD. Large-scale randomized trials will have to confirm these findings.
BACKGROUND: Many high-volume centers are implementing RPD as an alternative to open pancreatoduodenectomy (OPD) but the persevering concerns about increased costs of RPD versus OPD have not been addressed by large studies.
METHODS: Post hoc cost analysis of consecutive RPD versus OPD in a singly high-volume center (January 2015-June 2024). The eligibility criteria for RPD (ie, no vascular contact, no chronic and necrotizing pancreatitis, and body mass index <35 kg/m 2 ) were used to select patients undergoing OPD to minimize selection bias. Primary outcomes were total hospital costs and total hospital stay. Sensitivity analyses excluded the first half of the RPD experience.
RESULTS: Overall, 588 patients undergoing pancreatoduodenectomy were included (214 RPDs, 374 OPDs). Total hospital stay was shorter after RPD [10 days (6 to 17) vs 12 (8 to 21), P = 0.001]. Mean total hospital costs were €4804 higher for RPD (€27,307 vs €22,503, P = 0.010). Outcomes improved in the second half of the RPD experience (n = 107): total hospital stay [12 days (7 to 23) to 9 (6 to 15), P < 0.001], pancreatic fistula (48.6% to 31.8%, P = 0.012), delayed gastric emptying (33.6% to 15.0%, P = 0.001), and operative time [373 minutes (341 to 411) to 310 (272 to 352), P <0.001]. Consequently, costs per RPD procedure decreased by €11,058 (€32,836 to €21,778, P = 0.001). Costs in the second half of the OPD experience remained stable (€24,025 to €21,013, P = 0.210). Hence, total hospital costs for RPD and OPD became comparable in the second half (€21,778 vs €21,013, P = 0.644).
CONCLUSIONS: Implementing RPD is associated with considerable additional costs compared with OPD. With growing experience, both the outcomes and cost-efficiency of RPD improve, with costs decreasing by approximately a third, leading to similar costs as OPD. Large-scale randomized trials will have to confirm these findings.