机器人辅助立体定向血肿引流术治疗自发性脑出血疗效及卫生经济学评价

Efficacy and health economic evaluation of robot-assisted stereotactic hematoma drainage for spontaneous intracerebral hemorrhage

目的探讨机器人辅助立体定向血肿引流术治疗自发性脑出血(SICH)的临床疗效及卫生经济学评价。方法收集首都医科大学附属北京朝阳医院神经外科自2019年3月至2022年3月行手术治疗的199例SICH患者的临床资料和经济数据。将所有患者按手术方式分为4组:机器人手术组77例,采用机器人辅助立体定向血肿引流术;神经内镜组65例,采用神经内镜下血肿清除术;小骨窗开颅组21例,采用小骨窗开颅显微镜下血肿清除术;硬通道组36例,采用硬通道血肿清除术。对比分析4组患者术后近期至1年的临床随访结果和医疗费用指标。选择机器人手术及内镜手术患者的数据,采用倾向性评分方法进行抽样匹配,以改良Rankin量表(mRS)评分和质量调整生命年(QALYs)指标进行卫生经济学评价。结果手术后出院时,4组患者的手术时间、术后血肿残余量、住院总费用、手术相关费用、ICU住院天数、呼吸机使用时间等方面比较,差异具有统计学意义(P<0.05);其中机器人手术组中再出血、颅内感染的发生率分别为2.6%、1.3%,平均住院时间15.45 d,平均住院费用46077.90元。4组患者中mRS≤3分比例比较,差异具有统计学意义(P<0.05),其中机器人手术组术后3个月和1年的mRS≤3分的患者比例分别为55.8%和74.0%。采用倾向性评分抽样匹配,最终得到均衡可比的机器人手术组及神经内镜组,每组37例。手术后1年,机器人手术组能够人均节省36862.14元的成本并多获得0.062个QALYs。结论机器人辅助立体定向血肿引流术具有成本更低且疗效更好的卫生经济学优势,更进一步的结果有待于开展多中心、扩大样本量的前瞻性随机对照研究。

Objective To investigate the clinical efficacy and health economic evaluation of hematoma drainage for spontaneous intracerebral hemorrhage(SICH)with the assistance of neurosurgical navigation and positioning planning system(referred to as robot).Methods The clinical data and economic data of 199 SICH patients who underwent surgical treatment from March 2019 to March 2022 were collected.All patients were divided into 4 groups according to surgical methods:the robotic surgery group consisted of 77 patients who underwent robot assisted stereotactic hematoma drainage surgery;65 cases in the neuro-endoscopy groups underwent hematoma removal surgery under neuroendoscopy;21 cases in the small bone window craniotomy group underwent microscopic hematoma removal with small bone window open;36 cases in the rigid catheter group underwent CT image-guided free-hand rigid catheter technique.Clinical follow-up outcomes and medical cost from the immediate post-operative to one year period were compared and analyzed.Data from both the robotic surgery and neuro-endoscopy groups were sampled and matched using propensity scoring methods,and health economics were evaluated using modified Rankin scale(mRS)scores and quality adjusted life years(QALYs)indicators.Results At the time of discharge,there were differences between the groups in terms of operation time,hematoma residual volume,total hospital costs,surgery-related costs,number of days in the ICU,and duration of ventilator use(P<0.05).In the robotic surgery group complication rate of rebleeding was 2.6%,intracranial infection was 1.3%,average hospital stay was 15.45 d,and average hospital cost was ¥46077.90.There was difference in the proportion of mRS≤3 points between the 4 groups(P<0.05),in which the proportion of patients with mRS≤3 points at 3 months and 1 year after surgery in the robotic surgery group was 55.8% and 74.0%,respectively.Propensity score sampling was matched,resulting in 37 patients each in the balanced and comparable robotic surgery and neuro-endoscopy groups.One year after surgery,the robotic surgery group was able to save ¥36862.14 per capita and gain 0.062 more QALYs.Conclusion Based on our model of SICH calculations suggest that robotic-assisted stereotactic drainage has the health economic advantage of being less costly and more effective,further results await multicenter,prospective randomized controlled trials with expanded sample size.