Cost-effectiveness analysis of robot-assisted laparoscopic surgery for complex pediatric surgical conditions.

BACKGROUND: Robotics has been used safely and successfully in a variety of adult surgeries and is gradually gaining ground in pediatrics. While the benefits of robotic-assisted surgery in disease treatment are well recognized, its high cost has led to questions. To investigate whether robotic-assisted laparoscopic surgery (RALS) is cost-effective compared to conventional laparoscopic surgery (LS) in pediatric surgery, we attempted to construct a model to perform an analysis of these two surgical approaches using Python statistical analysis software. METHODS: We selected four common complex pediatric surgical conditions (choledochal cyst, Hirschsprung's disease, vesicoureteral reflux, and congenital hydronephrosis) from three systems (pediatric hepatobiliary, gastroenterology, and urology). Models were constructed using Python statistical software to compare hospital costs and surgical outcomes for RALS and LS. In addition, we performed a preferred strategy analysis for both surgical modalities while assessing model uncertainty using one-way sensitivity analysis. RESULTS: For the four diseases, the operative time decreased sequentially. The total inpatient costs of RALS were 10,816.72, 9145.44, 8414.29, 7973.58 dollars, respectively, yielding 1.789, 1.712, 1.749, 1.792 quality adjustment life years (QALYs) over two years post-operatively. The incremental cost of RALS relative to LS for each disease was 3523.44, 3200.20, 3049.79, 3043.66 dollars, respectively, with an incremental utility of 0.060, 0.054, 0.051, 0.050 QALYs. The incremental cost-effectiveness ratios (ICERs) for RALS for each of the four diseases were 58,724.01, 59,262.95, 59,799.79, 60,873.20 dollars/QALY, all less than 100,000 dollars/QALY. The cost of robot consumables was the main incremental cost of RALS and had the most significant impact on the model. CONCLUSION: For the four pediatric surgical conditions described above, RALS has higher inpatient costs than LS, but it has better postoperative outcomes, and all four RALS treatments are cost-effective. Children with complex diseases and long operative times appear to benefit more from RALS.

[Determination of 88 pesticide residues in cranberry plant extract by gas chromatography-triple quadrupole tandem mass spectrometry].

A method by using a modified QuEChERS (quick, easy, cheap, effective, rugged and safe) and gas chromatography-triple quadrupole tandem mass spectrometry (GC-MS/MS) was established to analyze 88 pesticide residues in cranberry plant extract. The sample was extracted with acetone-hexane (1: 1, v/v) containing 1% acetic acid, then cleaned-up by ethylenediamine-N-propyl silyl (PSA) and graphite carbon (GCB). The extract was determined by GC-MS/MS in multi-reaction monitoring (MRM) mode, and external standard method was applied to quantified the pesticides. All the 88 pesticides showed good linearity in the range of 0. 001 - 0. 2 mg/L, and the limits of quantification (LOQs, S/N > or = 10) were all less than 31. 5 microg/kg. The average recoveries of all the pesticides were in the range of 71. 4% to 116. 6% at three spiked levels of 5, 25 and 50 microg/kg in cranberry plant extract, with the relative standard deviations (RSDs) of 2. 4% - 16. 9%. The results demonstrated that this method is simple, rapid and suitable for the determination of 88 pesticide residues in cranberry plant extract. The analytical sensitivity and accuracy can meet the requirements of multiple pesticide residue analysis.