Nurse-led coordinated surgical care pathways for cost optimization of robotic-assisted partial nephrectomy: medico-economic analysis of the UroCCR-25 AMBU-REIN study.
World J Urol
; 41(2): 325-333, 2023 Feb.
Article
en En
| MEDLINE
| ID: mdl-35727334
ABSTRACT
PURPOSE:
Robot-assisted partial nephrectomy (RAPN) reduces morbidity, enabling development of Enhanced Recovery After Surgery (ERAS) and day-case protocols. Additional financial costs limit its integration into clinical practice. We evaluated the medico-economic impact of RAPN using a nurse-led coordinated pathway of care (NLC-RAPN).METHODS:
All tumor RAPNs performed in 2017 were prospectively included in nurse-led protocols NP-RAAC (ERAS) or Ambu-Rein (day case). Clinico-biological and pathological data were prospectively collected within the French Research Network for Kidney Cancer database (NCT03293563). Estimated costs were compared to "average" patients at the national level operated by open partial nephrectomy (OPN) or RAPN, using data from the 2017 French hospital discharge database and the national cost scale.RESULTS:
The NLC-RAPN cohort (n = 151) included 27 (18%) outpatients and the average hospital length of stay (LOS) was 2.4 days. In the national control cohorts for OPN (n = 2475) and RAPN (n = 3529), the average LOS were 8.0 and 5.2 days, respectively. The mean incomes per group were 7607 for NLC-RAPN, 9813 for OPN, and 8215 for RAPN. The mean daily cost of stay was 659 for NLC-RAPN, 838 for OPN, and 725 for RAPN. The overall cost for NLC-RAPN was 6594, 8733 for OPN, and 8763 for RAPN. The best operational margin was obtained for day-case NLC-RAPN (1967).CONCLUSION:
Combining RAPN with nurse-led coordinated pathways of care led to a shorter hospital stay and reduced costs versus OPN. This may facilitate the economic sustainability of robotic assistance for hospitals where the extra cost is not covered by the healthcare system.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Procedimientos Quirúrgicos Robotizados
/
Neoplasias Renales
Tipo de estudio:
Guideline
/
Health_economic_evaluation
Límite:
Humans
Idioma:
En
Revista:
World J Urol
Año:
2023
Tipo del documento:
Article
País de afiliación:
Francia