Robotische versus offene Pankreaschirurgie - Eine Propensity Score Matched Kosteneffektivitäts-Analyse

Benzing, Christian; Timmermann, Lea; Winklmann, Thomas; Haiden, Lena Marie; Feist, Mathilde; Hillebrandt, KH; Winter, A.; Maurer, MM; Krenzien, Felix; Felsenstein, Matthäus; Schmelzle, Moritz; Pratschke, Johann; Malinka, Thomas

doi:10.1055/s-0041-1733598

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“…The exclusion criteria were patients who underwent procedures other than PPPD/Whipple’s procedure/DP/TP such as draining procedures (e.g., Partington-Rochelle), or enucleations; conversion from RPS to OPS; laparoscopic pancreatic and hybrid (laparoscopic + open) surgery; multivisceral resection (i.e., resections of three or more organs), concomitant colorectal resections; and major hepatectomy, respectively, patients who were operated in 2019 and were still hospitalized in 2020. Of note, an oral presentation which included parts of the data from the current report with different inclusion criteria was held in 2021 at the Viszeralmedizin congress in Leipzig, Germany [ 23 ]. Figure 1 shows the patient selection process.…”

Section: Methodsmentioning

confidence: 99%

Robotic versus open pancreatic surgery: a propensity score-matched cost-effectiveness analysis

Benzing

Timmermann

Winklmann

et al. 2022

Langenbecks Arch Surg

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Background Robotic pancreatic surgery (RPS) is associated with high intraoperative costs compared to open pancreatic surgery (OPS). However, it remains unclear whether several advantages of RPS such as reduced surgical trauma and a shorter postoperative recovery time could lead to a reduction in total costs outweighing the intraoperative costs. The study aimed to compare patients undergoing OPS and RPS with regards to cost-effectiveness in a propensity score-matched (PSM) analysis. Methods Patients undergoing OPS and RPS between 2017 and 2019 were included in this monocentric, retrospective analysis. The controlling department provided financial data (costs and revenues, net loss/profit). A propensity score-matched analysis was performed or OPS and RPS (matching criteria: age, American society of anesthesiologists (ASA) score, gender, body mass index (BMI), and type of pancreatic resection) with a caliper 0.2. Results In total, 272 eligible OPS cases were identified, of which 252 met all inclusion criteria and were thus included in the further analysis. The RPS group contained 92 patients. The matched cohorts contained 41 patients in each group. Length of hospital stay (LOS) was significantly shorter in the RPS group (12 vs. 19 days, p = 0.003). Major postoperative morbidity (Dindo/Clavien ≥ 3a) and 90-day mortality did not differ significantly between OPS and RPS (p > 0.05). Intraoperative costs were significantly higher in the RPS group than in the OPS group (7334€ vs. 5115€, p < 0.001). This was, however, balanced by other financial categories. The overall cost-effectiveness tended to be better when comparing RPS to OPS (net profit—RPS: 57€ vs. OPS: − 2894€, p = 0.328). Binary logistic regression analysis revealed major postoperative complications, longer hospital stay, and ASA scores < 3 were linked to the risk of net loss (i.e., costs > revenue). Conclusions Surgical outcomes of RPS were similar to those of OPS. Higher intraoperative costs of RPS are outweighed by advantages in other categories of cost-effectiveness such as decreased lengths of hospital stay.

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Section: Methodsmentioning

confidence: 99%