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Betser L, Le Bras A, Etienne H, Roussel A, Bobbio A, Al-Zreibi C, Martinod E, Alifano M, Castier Y, Assouad J, Durand-Zaleski I, Mordant P. Outcomes and costs with the introduction of robotic-assisted thoracic surgery in public hospitals. J Robot Surg 2024; 18:124. [PMID: 38492119 DOI: 10.1007/s11701-024-01879-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/20/2024] [Indexed: 03/18/2024]
Abstract
Robotic-assisted thoracic surgery (RATS) is an effective treatment of non-small cell lung cancer (NSCLC) but the effects of its implementation in university hospital networks has not been described. We analyzed the early clinical outcomes, estimated costs, and revenues associated with three robotic systems implemented in the Paris Public Hospital network. A retrospective study included patients who underwent RATS for NSCLC in 2019 and 2020. Ninety-day morbidity, mortality, hospital costs, and hospital revenues were described. Economic analyses were conducted either from the hospital center or from the French health insurance system perspectives. Cost drivers were tested using univariate and multivariable analyses. Sensitivity analyses were performed to assess uncertainty over in-hospital length of stay (LOS), number of robotic surgeries per year, investment cost, operating room occupancy time, maintenance cost, and commercial discount. The study included 188 patients (65.8 ± 9.3 years; Charlson 4.1 ± 1.4; stage I 76.6%). Median in-hospital LOS was 6 days [5-9.5], 90-day mortality was 1.6%. Mean hospital expenses and revenues were €12,732 ± 4914 and €11,983 ± 5708 per patient, respectively. In multivariable analysis, factors associated with hospital costs were body mass index, DLCO, major complications, and transfer to intensive care unit. Sensitivity analyses showed that in-hospital LOS (€11,802-€15,010) and commercial discounts on the list price (€11,458-€12,732) had an important impact on costs. During the first 2 years following the installation of three robotic systems in Paris Public Hospitals, the clinical outcomes of RATS for NSCLC have been satisfactory. Without commercial discount, hospital expenses would have exceeded hospital revenues.Clinical registration number CNIL, N°2221601, CERC-SFCTCV-2021-07-20-Num17_MOPI_robolution.
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Affiliation(s)
- Léa Betser
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Alicia Le Bras
- Clinical Research Unit Eco Ile de France, Hôtel-Dieu, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Harry Etienne
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Arnaud Roussel
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Antonio Bobbio
- Department of Thoracic Surgery, Hôpital Cochin, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Charles Al-Zreibi
- Department of Thoracic Surgery, Hôpital Européen Georges Pompidou, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Emmanuel Martinod
- Department of Thoracic and Vascular Surgery, Hôpital Avicenne, Bobigny, France
- Hôpitaux de Paris, Paris, France
| | - Marco Alifano
- Department of Thoracic Surgery, Hôpital Cochin, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Yves Castier
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Jalal Assouad
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Isabelle Durand-Zaleski
- Clinical Research Unit Eco Ile de France, Hôtel-Dieu, Paris, France
- Department of Public Health, Université Paris Est, Hôpital Henri Mondor, Créteil, France
- Hôpitaux de Paris, Paris, France
| | - Pierre Mordant
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France.
- Hôpitaux de Paris, Paris, France.
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Le Pimpec-Barthes F, Rendina Iaffaldano AG, Masmoudi H, Al-Zreibi C. Now exists a scientific proof of increased lymphatic pumping using octreotide: what is its actual role in the chylothorax healing process? Eur J Cardiothorac Surg 2024; 65:ezad416. [PMID: 38407358 DOI: 10.1093/ejcts/ezad416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/23/2024] [Indexed: 02/27/2024] Open
Affiliation(s)
| | | | - Hicham Masmoudi
- Department of Thoracic Surgery, European Hospital Georges Pompidou, Paris, France
| | - Charles Al-Zreibi
- Department of Thoracic Surgery, European Hospital Georges Pompidou, Paris, France
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