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Surgical Endoscopy

Published in:

01-04-2011

Safety, efficacy, and cost-effectiveness of common laparoscopic procedures

Authors: Manish M. Tiwari, Jason F. Reynoso, Robin High, Albert W. Tsang, Dmitry Oleynikov

Published in: Surgical Endoscopy | Issue 4/2011

Abstract

Background

Laparoscopic surgery has been shown to offer superior surgical outcomes for most abdominal surgical procedures. However, there is hardly any evidence on surgical outcomes with patient risk stratification. This study aimed to compare outcomes of common laparoscopic and open surgical procedures for varying illness severity.

Methods

A retrospective analysis of surgical outcomes for six commonly performed surgical procedures including cholecystectomy, appendectomy, reflux surgery, gastric bypass surgery, ventral hernia repair, and colectomy was performed using the University HealthSystem Consortium (UHC) Clinical Database/Resource Manager (CDB/RM). The 3-year discharge data for the six commonly performed laparoscopic surgical procedures were analyzed for outcome measures including observed mortality, overall patient morbidity, intensive care unit (ICU) admissions, 30-day readmissions, length of hospital stay, and hospital costs.

Results

In this study, 208,314 patients underwent one of six common surgical procedures by either the open or the laparoscopic approach. Overall, the laparoscopic approach showed significantly lower mortality, reduced morbidity, fewer ICU admissions and 30-day readmissions, shorter hospital stay, and significantly reduced hospital costs for all the procedures. At stratification by illness severity, the laparoscopic group showed better or comparable surgical outcomes across all the illness severity groups. However, the observed mortality was comparable for the minor and moderate severity patients between laparoscopic and open surgery for most procedures. The 30-day readmission rate for major/extreme severity patients was comparable between the two groups for most surgical procedures.

Conclusions

This study demonstrated the superiority of laparoscopy over conventional open surgery across all illness severity risk groups for common surgical procedures. The results in general show that laparoscopic surgery is safe, efficacious, and cost-effective compared with open surgery and suggest that laparoscopic surgery should be the procedure of choice for all common surgical procedures, regardless of illness severity.

Abraham NS, Young JM, Solomon MJ (2004) Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 91:1111–1124PubMedCrossRef

Ackroyd R, Watson DI, Majeed AW, Troy G, Treacy PJ, Stoddard CJ (2004) Randomized clinical trial of laparoscopic versus open fundoplication for gastro-oesophageal reflux disease. Br J Surg 91:975–982PubMedCrossRef

Attwood SE, Hill AD, Murphy PG, Thornton J, Stephens RB (1992) A prospective randomized trial of laparoscopic versus open appendectomy. Surgery 112:497–501PubMed

Bencini L, Sanchez LJ, Boffi B, Farsi M, Scatizzi M, Moretti R (2003) Incisional hernia: repair retrospective comparison of laparoscopic and open techniques. Surg Endosc 17:1546–1551PubMedCrossRef

Bergqvist D (2009) Introduction of new technology: the surgical point of view. Scand J Surg 98:3–7PubMed

Colquitt J, Clegg A, Sidhu M, Royle P (2003) Surgery for morbid obesity. Cochrane Database Syst Rev 2:CD003641

Earle D, Seymour N, Fellinger E, Perez A (2006) Laparoscopic versus open incisional hernia repair: a single-institution analysis of hospital resource utilization for 884 consecutive cases. Surg Endosc 20:71–75PubMedCrossRef

Eshraghi N, Farahmand M, Soot SJ, Rand-Luby L, Deveney CW, Sheppard BC (1998) Comparison of outcomes of open versus laparoscopic Nissen fundoplication performed in a single practice. Am J Surg 175:371–374PubMedCrossRef

Forbes SS, Eskicioglu C, McLeod RS, Okrainec A (2009) Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 96:851–858PubMedCrossRef

10.

Heikkinen TJ, Haukipuro K, Hulkko A (1998) Cost-effective appendectomy: open or laparoscopic? A prospective randomized study. Surg Endosc 12:1204–1208PubMedCrossRef

11.

Hinojosa MW, Murrell ZA, Konyalian VR, Mills S, Nguyen NT, Stamos MJ (2007) Comparison of laparoscopic vs open sigmoid colectomy for benign and malignant disease at academic medical centers. J Gastrointest Surg 11:1423–1429 (discussion 1429–1430)PubMedCrossRef

12.

Hope WW, Lincourt AE, Newcomb WL, Schmelzer TM, Kercher KW, Heniford BT (2008) Comparing quality-of-life outcomes in symptomatic patients undergoing laparoscopic or open ventral hernia repair. J Laparoendosc Adv Surg Tech A 18:567–571PubMedCrossRef

13.

Janson M, Edlund G, Kressner U, Lindholm E, Pahlman L, Skullman S, Anderberg B, Haglind E (2009) Analysis of patient selection and external validity in the Swedish contribution to the COLOR trial. Surg Endosc 23:1764–1769PubMedCrossRef

14.

Katkhouda N, Mason RJ, Towfigh S, Gevorgyan A, Essani R (2005) Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg 242:439–448 (discussion 448–450)PubMed

15.

Kemp JA, Finlayson SR (2008) Nationwide trends in laparoscopic colectomy from 2000 to 2004. Surg Endosc 22:1181–1187PubMedCrossRef

16.

Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ (2006) Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev 4:CD006231

17.

Kiviluoto T, Siren J, Luukkonen P, Kivilaakso E (1998) Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet 351:321–325PubMedCrossRef

18.

Merhoff AM, Merhoff GC, Franklin ME (2000) Laparoscopic versus open appendectomy. Am J Surg 179:375–378PubMedCrossRef

19.

Nguyen NT, Goldman C, Rosenquist CJ, Arango A, Cole CJ, Lee SJ, Wolfe BM (2001) Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 234:279–289 (discussion 289–291)PubMedCrossRef

20.

Nguyen NT, Zainabadi K, Mavandadi S, Paya M, Stevens CM, Root J, Wilson SE (2004) Trends in utilization and outcomes of laparoscopic versus open appendectomy. Am J Surg 188:813–820PubMedCrossRef

21.

Olmi S, Magnone S, Erba L, Bertolini A, Croce E (2005) Results of laparoscopic versus open abdominal and incisional hernia repair. JSLS 9:189–195PubMed

22.

Olmi S, Scaini A, Cesana GC, Erba L, Croce E (2007) Laparoscopic versus open incisional hernia repair: an open randomized controlled study. Surg Endosc 21:555–559PubMedCrossRef

23.

Peters MJ, Mukhtar A, Yunus RM, Khan S, Pappalardo J, Memon B, Memon MA (2009) Meta-analysis of randomized clinical trials comparing open and laparoscopic anti-reflux surgery. Am J Gastroenterol 104:1548–1561 (quiz 1547, 1562)

24.

Pokala N, Sadhasivam S, Kiran RP, Parithivel V (2007) Complicated appendicitis: is the laparoscopic approach appropriate? A comparative study with the open approach: outcome in a community hospital setting. Am Surg 73:737–741 (discussion 741–742)PubMed

25.

Quintana JM, Arostegui I, Cabriada J, Lopez de Tejada I, Perdigo L (2003) Predictors of improvement in health-related quality of life in patients undergoing cholecystectomy. Br J Surg 90:1549–1555PubMedCrossRef

26.

Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J (2006) Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 93:921–928PubMedCrossRef

27.

Richards KF, Fisher KS, Flores JH, Christensen BJ (1996) Laparoscopic Nissen fundoplication: cost, morbidity, and outcome compared with open surgery. Surg Laparosc Endosc 6:140–143PubMedCrossRef

28.

Ros A, Carlsson P, Rahmqvist M, Backman K, Nilsson E (2006) Nonrandomised patients in a cholecystectomy trial: characteristics, procedures, and outcomes. BMC Surg 6:17PubMedCrossRef

29.

Salloum RM, Bulter DC, Schwartz SI (2006) Economic evaluation of minimally invasive colectomy. J Am Coll Surg 202:269–274PubMedCrossRef

30.

Sauerland S, Lefering R, Neugebauer EA (2002) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 1:CD001546

31.

Sekhar N, Torquati A, Youssef Y, Wright JK, Richards WO (2007) A comparison of 399 open and 568 laparoscopic gastric bypasses performed during a 4-year period. Surg Endosc 21:665–668PubMedCrossRef

32.

Shabbir A, Roslani AC, Wong KS, Tsang CB, Wong HB, Cheong WK (2009) Is laparoscopic colectomy as cost beneficial as open colectomy? ANZ J Surg 79:265–270PubMedCrossRef

33.

Sporn E, Petroski GF, Mancini GJ, Astudillo JA, Miedema BW, Thaler K (2009) Laparoscopic appendectomy: is it worth the cost? Trend analysis in the U.S. from 2000 to 2005. J Am Coll Surg 208:179e2–185e2CrossRef

34.

Vanek VW, Rhodes R, Dallis DJ (1995) Results of laparoscopic versus open cholecystectomy in a community hospital. South Med J 88:555–566PubMed

35.

Varela JE, Wilson SE, Nguyen NT (2010) Laparoscopic surgery significantly reduces surgical-site infections compared with open surgery. Surg. Endosc 24:270–276

36.

Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM, Olon C, Cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484PubMedCrossRef

37.

Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G, Clinical Outcomes of Surgical Therapy (COST) Study Group (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287:321–328PubMedCrossRef

38.

Yong JL, Law WL, Lo CY, Lam CM (2006) A comparative study of routine laparoscopic versus open appendectomy. JSLS 10:188–192PubMed

Title: Safety, efficacy, and cost-effectiveness of common laparoscopic procedures
Authors: Manish M. Tiwari
Jason F. Reynoso
Robin High
Albert W. Tsang
Dmitry Oleynikov
Publication date: 01-04-2011
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 4/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-010-1328-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Safety, efficacy, and cost-effectiveness of common laparoscopic procedures

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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