A prospective case-matched comparison of clinical and financial outcomes of open versus laparoscopic colorectal resection

We aimed to assess the clinical outcomes and costs associated with laparoscopic resection within an elective colorectal practice.

Over a 12-month period data were prospectively collected on patients undergoing elective colorectal resection under the care of a single consultant surgeon. Thirty patients undergoing laparoscopic colorectal resection were case-matched by type of resection, disease process, and, where appropriate, cancer stage to patients having open surgery. A cost analysis was carried out incorporating cost of surgical bed stay, theater time, and specific equipment costs.

In the 30 patients having laparoscopic resection, a conversion rate of 13% was observed. Surgery was performed for colorectal cancer in 83% of patients, and 53% of resections were rectal. No significant differences were found in age (65 versus 69 years, p = 0.415), BMI (27.4 versus 26.1, p = 0.527), POSSUM physiology score (16 versus 16.5, p = 0.102), American Society of Anesthesiologists (ASA) grade (2 versus 2, p = 0.171), or length of theater time (160 min versus 160 min, p = 0.233) between the laparoscopic and open patients. Hospital stay was reduced in the laparoscopic group (5 versus 9 days, p < 0.001). Average cost of surgical equipment used for a laparoscopic resection was greater than for open surgery (£912.39 versus £276.41, p = 0.001). Cost of hospital stay was significantly less (£1259.75 versus £2267.55, p < 0.001). Cost of operating room time was similar for the two groups (£2066.63 versus £1945.07, p = 0.152). Overall no significant cost difference could be found between open and laparoscopic resection (£4560.9 versus £4348.45, p = 0.976). More postoperative complications were seen in the open resection group (14 versus 4, p < 0.001).

Intraoperative equipment costs are greater for laparoscopic resection than for open surgery. However, benefits can be seen in terms of quicker recovery and shorter hospital stay. Laparoscopic surgery is a financially viable alternative to open resection in selected patients.