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1.
Am Surg ; 86(3): 256-260, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32223807

RESUMO

Minimally invasive sigmoid colectomy via the laparoscopic approach (LA) has numerous benefits. We seek to compare outcomes between laparoscopic and robotic sigmoid colectomies. We analyzed the data using the National Inpatient Sample database between 2008 and 2014. Utilization and outcome measures were compared. The seven-year average number of patients who underwent elective sigmoid colectomy in the United States from 2008 to 2014 was estimated to be 197,053. Of these, 95.1 per cent were conducted using the LA. The mean age was 58.33 + 13.6 years and 58.23 + 12.8 years in laparoscopic and robotic approaches, respectively. No significant differences existed in respect to morbidities. Postoperative complications were comparable with respect to other complications. Length of hospital stay was statistically significantly shorter in the robot-assisted approach compared with the LA (mean 4.8 + 4 vs 5.7 + 5 days, respectively, P < 0.001). Patients who underwent robotic surgery had significantly higher total hospital charges than those who underwent laparoscopic surgery (median $45,057 vs $57,871 USD, P < 0.001). The advent of robot-assisted surgery has provided more options for patients and surgeons. Compared with laparoscopy, robot-assisted sigmoid colectomy has no clinical advantages in morbidity and mortality. However, the robotic approach has a significantly higher total charge to the patient.


Assuntos
Colectomia/métodos , Custos Hospitalares , Laparoscopia/métodos , Tempo de Internação/economia , Procedimentos Cirúrgicos Robóticos/economia , Adulto , Idoso , Colectomia/economia , Colo Sigmoide/cirurgia , Análise Custo-Benefício , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos/economia , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Seguimentos , Custos de Cuidados de Saúde , Humanos , Laparoscopia/economia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Medição de Risco , Procedimentos Cirúrgicos Robóticos/métodos , Estados Unidos
2.
J Surg Oncol ; 121(4): 670-675, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31967336

RESUMO

BACKGROUND: Minimally invasive surgery (MIS) is preferred for distal pancreatectomy but is not always attempted due to the risk of conversion to open. We hypothesized that the total cost for MIS converted to open procedures would be comparable to those that started open. METHODS: A prospectively collected institutional registry (2011-2017) was reviewed for demographic, clinical, and perioperative cost data for patients undergoing distal pancreatectomy. RESULTS: There were 80 patients who underwent distal pancreatectomy: 41 open, 39 MIS (11 laparoscopic and 28 robotic). Conversion to open occurred in 14 of 39 (36%, 3 laparoscopic and 11 robotic). Length of stay was shorter for the MIS completed (6 days; range, 3-8), and MIS converted to open (7 days; range, 4-10) groups, compared with open (10 days; range, 5-36; P = .003). Laparoscopic cases were the least expensive (P = .02). Robotic converted to open procedures had the highest operating room cost. However, the total cost for robotic converted to open cohort was similar to the open cohort due to cost savings associated with a shorter length of stay. CONCLUSIONS: Despite the higher intraoperative costs of robotic surgery, there is no significant overall financial penalty for conversion to open. Financial considerations should not play a role in selecting a robotic or open approach.


Assuntos
Pancreatectomia/economia , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Conversão para Cirurgia Aberta/economia , Conversão para Cirurgia Aberta/métodos , Conversão para Cirurgia Aberta/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde , Humanos , Laparoscopia/economia , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/economia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Pancreatectomia/estatística & dados numéricos , Sistema de Registros , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Estados Unidos
3.
J Surg Res ; 245: 136-144, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31419638

RESUMO

BACKGROUND: The role of robotic surgery in colorectal cancer remains contentious with most data arising from small, single-institution studies. METHODS: Stage I-III colorectal cancer resections from 2008 to 2014 were identified in New York State. Propensity score-adjusted negative binomial models were used to compare cost and utilization between robotic, laparoscopic, and open resections. RESULTS: A total of 12,218 patients were identified. For colectomy, the robotic-to-open conversion rate was 3%, and the laparoscopic-to-open conversion rate was 13%. For rectal resection, the robotic-to-open conversion rate was 7% and the laparoscopic-to-open conversion rate was 32%. In intention-to-treat analysis, there was no significant difference in cost across the surgical approaches, both in overall and stratified analyses. Both laparoscopic and robotic approaches were associated with decreased 90-d hospital utilization compared with open surgery in intention-to-treat analyses. CONCLUSIONS: Robotic and laparoscopic colorectal cancer resections were not associated with a hospital cost benefit after 90 d compared with open but were associated with decreased hospital utilization. Conversion to open resection was common, and efforts should be made to prevent them. Future research should continue to measure how robotic and laparoscopic approaches can add value to the health care system.


Assuntos
Neoplasias Colorretais/cirurgia , Utilização de Instalações e Serviços/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Idoso , Colectomia/economia , Colectomia/estatística & dados numéricos , Neoplasias Colorretais/economia , Conversão para Cirurgia Aberta/estatística & dados numéricos , Utilização de Instalações e Serviços/economia , Feminino , Humanos , Laparoscopia/economia , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , New York , Protectomia/economia , Protectomia/estatística & dados numéricos , Neoplasias Retais/economia , Procedimentos Cirúrgicos Robóticos/economia
4.
Bone Joint J ; 101-B(9): 1063-1070, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474149

RESUMO

AIMS: The primary aim of the study was to perform an analysis to identify the cost per quality-adjusted life-year (QALY) of robot-assisted unicompartmental knee arthroplasty (rUKA) relative to manual total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) for patients with isolated medial compartment osteoarthritis (OA) of the knee. Secondary aims were to assess how case volume and length of hospital stay influenced the relative cost per QALY. PATIENTS AND METHODS: A Markov decision analysis was performed, using known parameters for costs, outcomes, implant survival, and mortality, to assess the cost-effectiveness of rUKA relative to manual TKA and UKA for patients with isolated medial compartment OA of the knee with a mean age of 65 years. The influence of case volume and shorter hospital stay were assessed. RESULTS: Using a model with an annual case volume of 100 patients, the cost per QALY of rUKA was £1395 and £1170 relative to TKA and UKA, respectively. The cost per QALY was influenced by case volume: a low-volume centre performing ten cases per year would achieve a cost per QALY of £7170 and £8604 relative to TKA and UKA. For a high-volume centre performing 200 rUKAs per year with a mean two-day length of stay, the cost per QALY would be £648; if performed as day-cases, the cost would be reduced to £364 relative to TKA. For a high-volume centre performing 200 rUKAs per year with a shorter length of stay of one day relative to manual UKA, the cost per QALY would be £574. CONCLUSION: rUKA is a cost-effective alternative to manual TKA and UKA for patients with isolated medial compartment OA of the knee. The cost per QALY of rUKA decreased with reducing length of hospital stay and with increasing case volume, compared with TKA and UKA. Cite this article: Bone Joint J 2019;101-B:1063-1070.


Assuntos
Artroplastia do Joelho/economia , Artroplastia do Joelho/métodos , Osteoartrite do Joelho/cirurgia , Idoso , Artroplastia do Joelho/estatística & dados numéricos , Análise Custo-Benefício , Feminino , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Cadeias de Markov , Osteoartrite do Joelho/economia , Osteoartrite do Joelho/epidemiologia , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Reino Unido/epidemiologia
6.
Int J Med Robot ; 15(5): e2026, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31310418

RESUMO

BACKGROUNDS: Robotic surgeries have been used frequently for benign diseases in gynecology. However, the advantage of robotic surgery for huge uterus is unclear. METHODS: We analyzed surgical outcomes of 527 patients who underwent robotic hysterectomies for benign diseases, separating uterine sizes into five groups by every 250 g. RESULTS: Median operative time in the five groups was 123 minutes (<250 g), 130 minutes (250-500 g), 144 minutes (500-750 g), 180 minutes (750-1000 g), and 170 minutes (>1000 g). Median estimated blood loss was 50, 100, 100, 200, and 400 mL in the five groups, respectively. The incidence of intraoperative complications did not correlate with uterine weight. CONCLUSIONS: Operative time, estimated blood loss, and the incidence of conversion to laparotomy increased with uterine size during robotic hysterectomies, especially evident in a uterus >750 g.


Assuntos
Histerectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Perda Sanguínea Cirúrgica , Estudos Transversais , Feminino , Custos de Cuidados de Saúde , Humanos , Histerectomia/efeitos adversos , Histerectomia/economia , Pessoa de Meia-Idade , Duração da Cirurgia , Tamanho do Órgão , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/economia , Útero
7.
Langenbecks Arch Surg ; 404(5): 615-620, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31300891

RESUMO

PURPOSE: The da Vinci Surgical System family remains the most widely used surgical robotic system for laparoscopy. Data about gastric bypass surgery with the Xi Surgical System are not available yet. We compared Roux-en-Y gastric bypass surgery performed at our institution with the da Vinci Xi and the da Vinci Si Surgical System. METHODS: All robotic gastric bypass procedures performed between January 2013 and September 2016 were analyzed retrospectively. Patient demographics and operative and postoperative outcomes up to 30 days were compared for the da Vinci Xi and Si Surgical System. Robotic costs per procedure were modeled including posts for a standard set of robotic instruments, capital investment, and yearly maintenance. RESULTS: One-hundred forty-four Xi Surgical System and 195 Si Surgical System procedures were identified. Mean age (p = 0.9), gender distribution (p = 0.8), BMI (p = 0.6), and ASA scores (p > 0.5) were similar in both cohorts. Operating room times were similar in both groups (219.4 ± 58.8 vs. 227.4 ± 60.5 min for Xi vs. Si, p = 0.22). Docking times were significantly longer with the Xi compared with the Si Surgical System (9 ± 4.8 vs. 5.8 ± 4 min, p < 0.0001). There was no difference in incidence of minor (13.9 vs. 10.3%, p = 0.3) and major complications (5.6 vs. 5.1%, p = 1 for Xi vs. Si). Costs were higher for the Xi Surgical System caused by higher capital investment and yearly maintenance. CONCLUSIONS: Roux-en-Y gastric bypass surgery can be safely performed with the Xi Surgical System, while drawbacks include longer docking times and higher costs.


Assuntos
Derivação Gástrica/instrumentação , Laparoscopia/instrumentação , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/instrumentação , Adulto , Feminino , Derivação Gástrica/efeitos adversos , Derivação Gástrica/economia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/economia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Duração da Cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/economia , Resultado do Tratamento
8.
Gynecol Oncol ; 154(2): 411-419, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31176554

RESUMO

OBJECTIVE: The majority of cost-studies related to robotic surgery has a short follow-up and primarily report the costs from the index surgery. The aim of this study was to evaluate the long-term resource consequences of introducing robotic surgery for early stage endometrial cancer in Denmark. METHODS: The study included all women with early stage endometrial cancer who underwent robotic, laparoscopic and open access surgery from January 2008 to June 2015. Data was linked from national databases to determine resource consumption and costs from hospital treatments, outpatient contacts, primary health care sector visits, labor market affiliation and prescription of medication. Each patient was observed in a period of 12 months before- and after surgery. The key exposure variable was women who were exposed to robotic surgery compared to those who were not. RESULTS: A total of 4133 women underwent surgery for early stage endometrial cancer. The study found additional costs of $7309 (95% confidence interval [CI] 2100-11,620, P = 0.001) per patient in the group exposed to robotic surgery including long-term costs post-surgery compared to the non-exposed group (non-robotic group). When controlling for time trends, the introduction of robotic surgery did not reduce the number of bed days (mean diff -0.42, 95% CI -3.03-2.19, P = 0.752). CONCLUSIONS: The introduction of robotic surgery for early stage endometrial cancer did not generate any long-term cost savings. The additional costs of robotic surgery were primarily driven by the index surgery. Any reduction in bed days could be explained by time trends.


Assuntos
Neoplasias do Endométrio/cirurgia , Custos Hospitalares/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/economia , Idoso , Estudos de Casos e Controles , Análise Custo-Benefício , Dinamarca/epidemiologia , Neoplasias do Endométrio/economia , Neoplasias do Endométrio/epidemiologia , Feminino , Humanos , Tempo de Internação/economia , Pessoa de Meia-Idade , Duração da Cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos
9.
Ann Surg ; 269(6): 1138-1145, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31082913

RESUMO

OBJECTIVE: To determine the impact of enhanced recovery after surgery (ERAS) pathway implementation on outcomes, and cost of robotic and open pancreatoduodenectomy. BACKGROUND: ERAS pathways have shown benefit in open pancreatoduodenectomy (OPD). The impact of ERAS on robotic pancreatoduodenectomy (RPD) is unknown. METHODS: Retrospective review of consecutive RPD and OPDs in the pre-ERAS (July, 2014-July, 2015) and ERAS (July, 2015-July, 2016) period. Univariate and multivariate logistic regression was used to determine impact of ERAS and operative approach alone, or in combination (pre-ERAS + OPD, pre-ERAS + RPD, ERAS + OPD, ERAS + RPD) on length of hospital stay (LOS) and overall cost. RESULTS: In all, 254 consecutive pancreatoduodenectomies (RPD 62%, OPD 38%) were analyzed (median age 67, 47% female). ERAS patients had shorter LOS (6 vs 8 days; P = 0.004) and decreased overall cost (USD 20,362 vs 24,277; P = 0.001) compared with non-ERAS patients, whereas RPD was associated with decreased LOS (7 vs 8 days; P = 0.0001) and similar cost compared with OPD. On multivariable analysis (MVA), RPD was predictive of shorter LOS [odds ratio (OR) 0.33, confidence interval (CI) 0.16-0.67, P = 0.002), whereas ERAS was protective against high cost (OR 0.57, CI 0.33-0.97, P = 0.037). On MVA, when combining operative approach with ERAS pathway use, a combined ERAS + RPD approach was associated with reduced LOS and optimal cost compared with other combinations (pre-ERAS + OPD, pre-ERAS + RPD, ERAS + OPD). CONCLUSION: ERAS implementation is independently associated with cost savings for pancreatoduodenectomy. A combination of ERAS and robotic approach synergistically decreases hospital stay and overall cost compared with other strategies.


Assuntos
Custos de Cuidados de Saúde , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/economia , Procedimentos Cirúrgicos Robóticos/economia , Idoso , Procedimentos Clínicos/economia , Feminino , Humanos , Tempo de Internação/economia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
10.
Tech Coloproctol ; 23(5): 461-470, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31069557

RESUMO

BACKGROUND: The aim of this study was to assess, whether robotic-assistance in ventral mesh rectopexy adds benefit to laparoscopy in terms of health-related quality of life (HRQoL), cost-effectiveness and anatomical and functional outcome. METHODS: A prospective randomized study was conducted on patients who underwent robot-assisted ventral mesh rectopexy (RVMR) or laparoscopic ventral mesh rectopexy (LVMR) for internal or external rectal prolapse at Oulu University Hospital, Finland, recruited in February-May 2012. The primary outcomes were health care costs from the hospital perspective and HRQoL measured by the 15D-instrument. Secondary outcomes included anatomical outcome assessed by pelvic organ prolapse quantification method and functional outcome by symptom questionnaires at 24 months follow-up. RESULTS: There were 30 females (mean age 62.5 years, SD 11.2), 16 in the RVMR group and 14 in the LVMR group. The surgery-related costs of the RVMR were 1.5 times higher than the cost of the LVMR. At 3 months the changes in HRQoL were 'much better' (RVMR) and 'slightly better' (LVMR) but declined in both groups at 2 years (RVMR vs. LVMR, p > 0.05). The cost-effectiveness was poor at 2 years for both techniques, but if the outcomes were assumed to last for 5 years, it improved significantly. The incremental cost-effectiveness ratio for the RVMR compared to LVMR was €39,982/quality-adjusted life years (QALYs) at 2 years and improved to €16,707/QALYs at 5 years. Posterior wall anatomy was restored similarly in both groups. The subjective satisfaction rate was 87% in the RVMR group and 69% in the LVMR group (p = 0.83). CONCLUSIONS: Although more expensive than LVMR in the short term, RVMR is cost-effective in long-term. The minimally invasive VMR improves pelvic floor function, sexual function and restores posterior compartment anatomy. The effect on HRQoL is minor, with no differences between techniques.


Assuntos
Custos e Análise de Custo , Laparoscopia/economia , Qualidade de Vida , Prolapso Retal/cirurgia , Procedimentos Cirúrgicos Robóticos/economia , Telas Cirúrgicas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
J Urol ; 202(5): 959-963, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31112102

RESUMO

PURPOSE: The typical mean length of stay following robot-assisted laparoscopic prostatectomy is 24 to 48 hours. We began routinely offering same day discharge from the hospital after robot-assisted laparoscopic prostatectomy. We evaluated the success rate, safety and cost implications in what is to our knowledge the only large series of same day discharge to date. MATERIALS AND METHODS: Beginning in September 2016 all patients were given the option of same day discharge without it being mandated. After allowing 3 months to solidify the protocol we evaluated our prospective database for the next 500 patients. RESULTS: Of the 500 consecutive men who underwent robot-assisted laparoscopic prostatectomy performed by 1 surgeon in 18 months 246 (49.2%) were discharged home the day of surgery and all of the remaining 254 were discharged the next day for a mean 0.51-day length of stay. Mean patient age was 62 years (range 42 to 81) and mean body mass index was 29.7 kg/m2 (range 20 to 53). Of the patients 34 (6.8%) had a Clavien-Dindo grade I-III complication within 90 days but there were no grade IV-V complications. Only 5 patients (1%) required an emergency department visit and only 8 (1.6%) required readmission. Only 1 of the patients who elected same day discharge was rehospitalized and only 1 presented to the emergency department. The estimated charge for an overnight stay at our institution is $2,109. The approximate reduction in charges was $518,814 during 18 months ($345,876 per year) with no increased cost due to emergency department visits or hospital readmissions compared with that of overnight patients. In the most recent 100 patients the rate of same day discharge improved to 65%. CONCLUSIONS: Same day discharge following robot-assisted laparoscopic prostatectomy can be safely routinely offered with no increase in readmissions or emergency visits. It may lead to significant savings in health care costs.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Alta do Paciente/estatística & dados numéricos , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/economia , Serviço Hospitalar de Emergência/economia , Utilização de Instalações e Serviços/economia , Utilização de Instalações e Serviços/estatística & dados numéricos , Estudos de Viabilidade , Custos Hospitalares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Ohio , Alta do Paciente/economia , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Prostatectomia/economia , Procedimentos Cirúrgicos Robóticos/economia
12.
Int J Surg ; 67: 54-60, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31121328

RESUMO

BACKGROUND: Laparoscopic liver resection is recommended as the standard operation for left lateral sectionectomy (LLS). Robotic liver resection is theoretically better than laparoscopic liver resection in complex cases of liver resection. However, in a complex case of LLS, whether robotic LLS (R-LLS) is still better than laparoscopic LLS (L-LLS) is unclear. This study aims to assess the perioperative outcomes of R-LLS and L-LLS in the overall and in the subgroup of complex cases of LLS. METHODS: From January 2015 to June 2017, the data on consecutive patients who underwent R-LLS were retrospectively compared with those who underwent L-LLS. Based on defined criteria for complex cases, the subgroup of such patients who underwent R-LLS were compared with the subgroup of patients who underwent L-LLS. The patient characteristics and surgical outcomes in the whole groups and subgroups of patients were analyzed. RESULTS: The overall R-LLS and L-LLS groups showed no significance differences in operative time, intraoperative blood loss, postoperative hospital stay, blood transfusion and morbidity rates. The overall medical costs were significantly higher in the R-LLS group than in the L-LLS group (12786.4 vs. 7974.3 USD; p < 0.001). On subgroup analysis of the complex cases, the estimated blood loss was significantly less in the R-LLS subgroup than the L-LLS subgroup (131.9 vs. 320.8 ml, p = 0.003). The two subgroups showed no significant differences in postoperative hospital stay (4.7 vs. 5.3 days; p = 0.054) and operative times (126.4 vs. 110.8 min; p = 0.379). The R-LLS subgroup had significantly higher overall medical costs than the L-LLS subgroup (13536.9 vs. 9186.7 USD, p = 0.006). CONCLUSION: The overall R-LLS group was comparable to the overall L-LLS group in perioperative outcomes. Although the overall medical costs in the robotic subgroup was higher, R-LLS might be a better choice for the subgroup of patients with complex cases when compared to L-LLS.


Assuntos
Custos de Cuidados de Saúde , Hepatectomia/economia , Laparoscopia/economia , Complicações Pós-Operatórias/economia , Procedimentos Cirúrgicos Robóticos/economia , Adulto , Perda Sanguínea Cirúrgica , Transfusão de Sangue/estatística & dados numéricos , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação/economia , Fígado/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento
13.
J Surg Res ; 241: 247-253, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31035139

RESUMO

BACKGROUND: The advent of robotic-assisted surgery has added an additional decision point in the treatment of inguinal hernias. The goal of this study was to identify the patient, surgeon, and hospital demographic predictors of robotic inguinal hernia repair (IHR). METHODS: We conducted a retrospective analysis of 102,241 IHRs (1096 robotic and 101,145 laparoscopic) from 2010 through 2015 with data collected in the Premier Hospital Database. The adjusted odds ratio (OR) of receiving a robotic IHR was calculated for each of several demographic factors using multivariable logistic regression. RESULTS: The rate of robotic IHR increased from 2010 through 2015. Age <65 y and Charlson comorbidity index were not predictors of a robotic IHR. Females were more likely to receive a robotic IHR (OR 1.69, confidence interval [CI] 1.40-2.05, P < 0.0001). Compared with white patients, black patients were more likely (OR 1.33, CI 1.06-1.68, P = 0.0138), and other race patients were less likely (OR 0.47, CI 0.38-0.58, P < 0.0001) to receive a robotic IHR. Compared with Medicare insurance, patients with all other types of insurance were more likely to receive a robotic IHR (OR > 1.00, lower limit of CI > 1.00, P < 0.05). Higher volume surgeons were less likely to perform robotic IHR (OR < 1.00, upper limit of CI < 1.00, P < 0.05). Nonteaching (OR 1.81, CI 1.53-2.13, P < 0.0001), larger (OR > 1.00, lower limit of CI > 1.00, P < 0.05), and rural (OR 1.27, CI 1.03-1.57, P = 0.025) hospitals were more likely to perform robotic IHR. Significant regional variation in the rate of robotic IHR was identified (OR > 1.00, lower limit of CI > 1.00, P < 0.05). CONCLUSIONS: The rate of robotic IHR is increasing exponentially. This study found that female gender, black race, insurance other than Medicare, lower surgeon annual volume, larger hospital size, nonteaching hospital status, rural hospital location, and hospital region were predictors of robotic IHR.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/estatística & dados numéricos , Seleção de Pacientes , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Afro-Americanos/estatística & dados numéricos , Idoso , Feminino , Herniorrafia/economia , Herniorrafia/tendências , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais Rurais/estatística & dados numéricos , Humanos , Masculino , Medicare/economia , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/tendências , Fatores Sexuais , Cirurgiões/estatística & dados numéricos , Estados Unidos , Carga de Trabalho/estatística & dados numéricos
14.
World Neurosurg ; 127: 576-587.e5, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30954747

RESUMO

BACKGROUND: Robotic guidance (RG) and navigation (NV) have been shown to reduce radiologic and clinically relevant pedicle screw malpositions. It remains unknown if there are any additional benefits to these techniques in intraoperative and perioperative end points. METHODS: We conducted a systematic review in MEDLINE, Embase, Scopus, and the Cochrane Library and identified controlled studies comparing RG, NV, and freehand (FH) thoracolumbar pedicle screw insertion and carried out random-effects meta-analyses. RESULTS: Thirty-two studies (24,008 patients) were included. Only 8 studies (26%) were randomized, and study quality was rated as very low or low in 24 cases (77%). Compared with NV, FH procedures showed longer length of hospital stay (Δ, 0.7 days; 95% confidence interval, 0.2-1.2; P = 0.006) and more overall complications (odds ratio, 1.6; 95% confidence interval, 1.3-1.9; P < 0.001). No statistically significant differences among RG and FH were identified, likely because of lack in statistical power (all P > 0.05). In particular, both RG and NV did not show increased intraoperative radiation use, as determined by seconds of fluoroscopy, compared with FH (both P > 0.05). CONCLUSIONS: It seems that navigation may offer potential benefits in perioperative outcomes such as length of hospital stay and overall complications, without significant increase in intraoperative radiation, which cannot yet be said for robotic guidance. The findings must be interpreted with caution, because the evidence is severely limited in both quantity and quality. Further evaluation will establish any demonstrable intraoperative or perioperative benefits to computer assistance, which may warrant the high costs often associated with these devices.


Assuntos
Vértebras Lombares/cirurgia , Parafusos Pediculares , Procedimentos Cirúrgicos Robóticos/métodos , Vértebras Torácicas/cirurgia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Análise Custo-Benefício , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Duração da Cirurgia , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/etiologia , Doses de Radiação , Procedimentos Cirúrgicos Robóticos/economia , Fusão Vertebral/economia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos
15.
Br J Surg ; 106(7): 910-921, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31012498

RESUMO

BACKGROUND: Minimally invasive distal pancreatectomy decreases time to functional recovery compared with open distal pancreatectomy, but the cost-effectiveness and impact on disease-specific quality of life have yet to be established. METHODS: The LEOPARD trial randomized patients to minimally invasive (robot-assisted or laparoscopic) or open distal pancreatectomy in 14 Dutch centres between April 2015 and March 2017. Use of hospital healthcare resources, complications and disease-specific quality of life were recorded up to 1 year after surgery. Unit costs of hospital healthcare resources were determined, and cost-effectiveness and cost-utility analyses were performed. Primary outcomes were the costs per day earlier functional recovery and per quality-adjusted life-year. RESULTS: All 104 patients who had a distal pancreatectomy (48 minimally invasive and 56 open) in the trial were included in this study. Patients who underwent a robot-assisted procedure were excluded from the cost analysis. Total medical costs were comparable after laparoscopic and open distal pancreatectomy (mean difference €-427 (95 per cent bias-corrected and accelerated confidence interval €-4700 to 3613; P = 0·839). Laparoscopic distal pancreatectomy was shown to have a probability of at least 0·566 of being more cost-effective than the open approach at a willingness-to-pay threshold of €0 per day of earlier recovery, and a probability of 0·676 per additional quality-adjusted life-year at a willingness-to-pay threshold of €80 000. There were no significant differences in cosmetic satisfaction scores (median 9 (i.q.r. 5·75-10) versus 7 (4-8·75); P = 0·056) and disease-specific quality of life after minimally invasive (laparoscopic and robot-assisted procedures) versus open distal pancreatectomy. CONCLUSION: Laparoscopic distal pancreatectomy was at least as cost-effective as open distal pancreatectomy in terms of time to functional recovery and quality-adjusted life-years. Cosmesis and quality of life were similar in the two groups 1 year after surgery.


Assuntos
Análise Custo-Benefício , Custos Hospitalares/estatística & dados numéricos , Laparoscopia/economia , Pancreatectomia/métodos , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Pancreatectomia/economia , Satisfação do Paciente , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Recuperação de Função Fisiológica , Método Simples-Cego
16.
J Urol ; 202(3): 539-545, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31009291

RESUMO

PURPOSE: The United States health care system is rapidly moving away from fee for service reimbursement in an effort to improve quality and contain costs. Episode based reimbursement is an increasingly relevant value based payment model of surgical care. We sought to quantify the impact of modifiable cost inputs on institutional financial margins in an episode based payment model for prostate cancer surgery. MATERIALS AND METHODS: A total of 157 consecutive patients underwent robotic radical prostatectomy in 2016 at a tertiary academic medical center. We compiled comprehensive episode costs and reimbursements from the most recent urology consultation for prostate cancer through 90 days postoperatively and benchmarked the episode price as a fixed reimbursement to the median reimbursement of the cohort. We identified 2 sources of modifiable costs with undefined empirical value, including preoperative prostate magnetic resonance imaging and perioperative functional recovery counseling visits, and then calculated the impact on financial margins (reimbursement minus cost) under an episode based payment. RESULTS: Although they comprised a small proportion of the total episode costs, varying the use of preoperative magnetic resonance imaging (33% vs 100% of cases) and functional recovery counseling visits (1 visit in 66% and 2 in 100%) reduced average expected episode financial margins up to 22.6% relative to the margin maximizing scenario in which no patient received these services. CONCLUSIONS: Modifiable cost inputs have a substantial impact on potential operating margins for prostate cancer surgery under an episode based payment model. High cost health systems must develop the capability to analyze individual cost inputs and quantify the contribution to quality to inform value improvement efforts for multiple service lines.


Assuntos
Planos de Pagamento por Serviço Prestado , Cuidados Pré-Operatórios/economia , Prostatectomia/economia , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/economia , Idoso , Redução de Custos/métodos , Aconselhamento/economia , Aconselhamento/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Humanos , Imagem por Ressonância Magnética/economia , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/estatística & dados numéricos , Próstata/diagnóstico por imagem , Próstata/cirurgia , Prostatectomia/métodos , Prostatectomia/estatística & dados numéricos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/economia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Estados Unidos
17.
J Robot Surg ; 13(5): 635-642, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30919259

RESUMO

Common benign gynecologic procedures include hysterectomies and myomectomies, with hysterectomy being the most common gynecologic procedure in the United States [1]. While historically performed via laparotomy, the field of gynecologic surgery was revolutionized with the advent of laparoscopic techniques, with the most recent advancement being the introduction of robotic-assisted surgery in 2005. Robotic surgery has all the benefits of laparoscopic surgery such as decreased blood loss, quicker return to activities, and shorter length of hospital stay. Additional robotic-specific advantages include but are not limited to improved ergonomics, 3D visualization, and intuitive surgical movements. Despite these advantages, one of the most commonly cited drawbacks of robotic surgery is the associated cost. While the initial cost to purchase the robotic console and its associated maintenance costs are relatively high, robotic surgery can be cost-effective when utilized correctly.This article reviews application strategies and factors that can offset traditional costs and maximize the benefits of robotic surgery.


Assuntos
Redução de Custos , Análise Custo-Benefício , Doenças dos Genitais Femininos/economia , Doenças dos Genitais Femininos/cirurgia , Histerectomia/economia , Laparoscopia/educação , Procedimentos Cirúrgicos Robóticos/economia , Miomectomia Uterina/economia , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Humanos , Histerectomia/métodos , Laparoscopia/métodos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/métodos , Miomectomia Uterina/métodos
18.
Surg Today ; 49(10): 795-802, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30859310

RESUMO

The robotic surgical system was designed to overcome the drawbacks of conventional endoscopic surgery. Since national health insurance in Japan began covering robotic-assisted thoracoscopic surgery (RATS) for malignant lung and mediastinal tumors in 2018, the number of RATS procedures being performed domestically has increased rapidly. This review evaluates the advantages and disadvantages of RATS for patients with lung cancers, based on an electronic literature search of PubMed. The main advantages of RATS are its ability to achieve excellent lymph-node removal with low morbidity and mortality, and minimal postoperative pain. Conversely, its disadvantages include a long operation time and the need for specialized instruments. However, the learning curve for RATS is reported to be shorter than that for VATS: some studies recommend that a surgeon needs to perform 18-22 robotic operations to attain sufficient skill. RATS for lung cancer is more expensive than VATS and the cost of training is high. Although the main disadvantage of RATS is that it reduces operator's tactile senses, the endoscope, which is directly manipulated by the surgeon at the console, using various magnifications, and 3D HD images on the monitor, may compensate for this. Ultimately, RATS offers better maneuverability, accuracy, and stability over VATS.


Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Toracoscopia/métodos , Competência Clínica , Educação Médica/economia , Cirurgia Geral/educação , Humanos , Curva de Aprendizado , Duração da Cirurgia , Dor Pós-Operatória/prevenção & controle , Pneumonectomia/economia , Pneumonectomia/instrumentação , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/instrumentação , Cirurgia Assistida por Computador , Cirurgia Torácica Vídeoassistida , Toracoscopia/economia , Toracoscopia/instrumentação
20.
J Cardiovasc Surg (Torino) ; 60(4): 526-531, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30916521

RESUMO

BACKGROUND: Robotic lobectomies for pulmonary pathologies, such as lung cancer, have seen increased usage over the past 10 years. Previous studies have shown that robotic lung surgery is safe and can lead to improved outcomes for patients. The purpose of this study was to compare postoperative complications associated with robotic lobectomy and video-assisted thoracoscopic surgery (VATS) lobectomy using the National Inpatient Sample (NIS) database in the USA. The use of this large, nationwide database may help clarify differences in outcomes of these two operative approaches. METHODS: Patients who underwent VATS and robotic lobectomy from 2010-2013 were identified using the NIS database. A propensity score matched analysis was applied in a 1:1 ratio to minimize imbalance between preoperative comorbidities. RESULTS: Final analysis included a total of 2868 patients: 1434 were VATS and 1434 were robotic cases. Postoperatively, the rate of overall morbidity was not statistically different in the VATS versus the robotic group (39.9% vs. 43.0%, P=0.084). Specific complications that were higher in the robotic group included: rates of accidental puncture or laceration (1.8% vs. 0.8%, P=0.016), pneumonia (5.7% vs. 4.1%, P=0.048), and bleeding complications (2.4% vs. 1.1%, P=0.012). Total costs were lower for the VATS group than the robotic group ($77,940.54 vs. $102,057.07, P<0.001). CONCLUSIONS: Overall morbidity between the two groups was not statistically different. Patients that underwent robotic versus VATS lobectomy were significantly more likely to experience accidental puncture or laceration, pneumonia, and bleeding complications. Robotic surgery also incurred more cost.


Assuntos
Pneumonectomia/métodos , Procedimentos Cirúrgicos Robóticos , Cirurgia Torácica Vídeoassistida , Idoso , Feminino , Hemorragia/etiologia , Humanos , Lesão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Pneumonia/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/economia , Cirurgia Torácica Vídeoassistida/efeitos adversos
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