Top

Published in:

01-04-2014

A cost comparison of laparoscopic and open colon surgery in a publicly funded academic institution

Authors: Krista M. Hardy, Josephine Kwong, Kristen B. Pitzul, Ashley S. Vergis, Timothy D. Jackson, David R. Urbach, Allan Okrainec

Published in: Surgical Endoscopy | Issue 4/2014

Abstract

Background

The objective of this study was to compare the total hospital cost of laparoscopic (lap) and open colon surgery at a publicly funded academic institution.

Methods

Patients undergoing elective laparoscopic or open colon surgery for all indications at the University Health Network, Toronto, Canada, from April 2004 to March 2009 were included. Patient demographic, operative, and outcome data were reviewed retrospectively. Hospital costs were determined from the Ontario Case Costing Initiative, adjusted for inflation, and compared using the Mann–Whitney U test. Linear regression was used to analyze the relationship between length of stay and total hospital cost.

Results

There were 391 elective colon resections (223 lap/168 open, 15.4 % conversion). There was no difference in median age, gender, or Charlson score. Body mass index was slightly higher for laparoscopic surgery (27.5/25.9 lap/open; p = 0.008), while the American Society of Anesthesiologists score was slightly higher for open surgery. Median operative time was greater for laparoscopic surgery (224/196 min, lap/open; p = 0.001). There was no difference in complication rates (21.6/22.5 % lap/open; p = 0.900), reoperations (5.8/6.5 % lap/open; p = 0.833) or 30-day readmissions (7.6/12.5 % lap/open; p = 0.122). Number of emergency room visits was greater with open surgery (12.6/20.8 % lap/open; p = 0.037). Operative cost was higher for laparoscopic surgery ($4,171.37/3,489.29 lap/open; p = 0.001), while total hospital cost was significantly reduced ($9,600.22/12,721.41 lap/open; p = 0.001). Median length of stay was shorter for laparoscopic surgery (5/7 days lap/open; p = 0.000), and this correlated directly with hospital cost.

Conclusions

Laparoscopic colon surgery is associated with increased operative costs but significantly lower total hospital costs. The cost savings is related, in part, to reduced length of stay with laparoscopic surgery.

Berends FJ, Kazemier G, Bonjer HJ, Lange JF (1994) Subcutaneous metastases after laparoscopic colectomy. Lancet 344(8914):58PubMedCrossRef

Fleshman JW, Nelson H, Peters WR, Kim HC, Larach S, Boorse RR et al (1996) Early results of laparoscopic surgery for colorectal cancer. Retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) study group. Dis Colon Rectum 39(10 Suppl):S53–S58PubMedCrossRef

Franklin ME Jr, Rosenthal D, Norem RF (1995) Prospective evaluation of laparoscopic colon resection versus open colon resection for adenocarcinoma. A multicenter study. Surg Endosc 9(7):811–816PubMed

Johnstone PA, Rohde DC, Swartz SE, Fetter JE, Wexner SD (1996) Port site recurrences after laparoscopic and thoracoscopic procedures in malignancy. J Clin Oncol 14(6):1950–1956PubMed

Reilly WT, Nelson H, Schroeder G, Wieand HS, Bolton J, O’Connell MJ (1996) Wound recurrence following conventional treatment of colorectal cancer. A rare but perhaps underestimated problem. Dis Colon Rectum 39(2):200–207PubMedCrossRef

Abraham NS, Young JM, Solomon MJ (2004) Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 91(9):1111–1124PubMedCrossRef

Nelson H, Sargent D, Wieand HS, Fleshman J, Anvari M, Stryker SJ, Clinical Outcomes of Surgical Therapy Study Group et al (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350(20):2050–2059CrossRef

Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97(11):1638–1645PubMedCrossRef

Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E et al (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10(1):44–52PubMedCrossRef

10.

Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A et al (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248(1):1–7PubMed

11.

Bonjer HJ, Hop WC, Nelson H, Sargent DJ, Lacy AM, Castells A et al (2007) Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 142(3):298–303PubMedCrossRef

12.

Robinson CN, Chen GJ, Balentine CJ, Sansgiry S, Marshall CL, Anaya DA et al (2011) Minimally invasive surgery is underutilized for colon cancer. Ann Surg Oncol 18(5):1412–1418PubMedCrossRef

13.

Rea JD, Cone MM, Diggs BS, Deveney KE, Lu KC, Herzig DO (2011) Utilization of laparoscopic colectomy in the United States before and after the clinical outcomes of surgical therapy study group trial. Ann Surg 254(2):281–288PubMedCrossRef

14.

Van Ye TM, Cattey RP, Henry LG (1994) Laparoscopically assisted colon resections compare favorably with open technique. Surg Laparosc Endosc 4(1):25–31PubMed

15.

Liberman MA, Phillips EH, Carroll BJ, Fallas M, Rosenthal R (1996) Laparoscopic colectomy vs traditional colectomy for diverticulitis. Outcome and costs. Surg Endosc 10(1):15–18PubMedCrossRef

16.

Philipson BM, Bokey EL, Moore JW, Chapuis PH, Bagge E (1997) Cost of open versus laparoscopically assisted right hemicolectomy for cancer. World J Surg 21(2):214–217PubMedCrossRef

17.

Bouvet M, Mansfield PF, Skibber JM, Curley SA, Ellis LM, Giacco GG et al (1998) Clinical, pathologic, and economic parameters of laparoscopic colon resection for cancer. Am J Surg 176(6):554–558PubMedCrossRef

18.

Young-Fadok TM, HallLong K, McConnell EJ, Gomez Rey G, Cabanela RL (2001) Advantages of laparoscopic resection for ileocolic Crohn’s disease Improved outcomes and reduced costs. Surg Endosc 15(5):450–454PubMedCrossRef

19.

Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238(1):67–72PubMedCentralPubMed

20.

Pokala N, Delaney CP, Senagore AJ, Brady KM, Fazio VW (2005) Laparoscopic vs open total colectomy: a case-matched comparative study. Surg Endosc 19(4):531–535PubMedCrossRef

21.

Sokolovic E, Buchmann P, Schlomowitsch F, Szucs TD (2004) Comparison of resource utilization and long-term quality-of-life outcomes between laparoscopic and conventional colorectal surgery. Surg Endosc 18(11):1663–1667PubMedCrossRef

22.

Maartense S, Dunker MS, Slors JF, Cuesta MA, Gouma DJ, van Deventer SJ et al (2004) Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis: a randomized trial. Ann Surg 240(6):984–991 discussion 91–92PubMedCentralPubMedCrossRef

23.

Janson M, Bjorholt I, Carlsson P, Haglind E, Henriksson M, Lindholm E et al (2004) Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer. Br J Surg 91(4):409–417PubMedCrossRef

24.

Senagore AJ, Brannigan A, Kiran RP, Brady K, Delaney CP (2005) Diagnosis-related group assignment in laparoscopic and open colectomy: financial implications for payer and provider. Dis Colon Rectum 48(5):1016–1020PubMedCrossRef

25.

Braga M, Vignali A, Zuliani W, Frasson M, Di Serio C, Di Carlo V (2005) Laparoscopic versus open colorectal surgery: cost-benefit analysis in a single-center randomized trial. Ann Surg 242(6):890–895 discussion 895–896PubMedCentralPubMedCrossRef

26.

Noblett SE, Horgan AF (2007) A prospective case-matched comparison of clinical and financial outcomes of open versus laparoscopic colorectal resection. Surg Endosc 21(3):404–408PubMedCrossRef

27.

Franks PJ, Bosanquet N, Thorpe H, Brown JM, Copeland J, Smith AM et al (2006) Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial). Br J Cancer 95(1):6–12PubMedCentralPubMedCrossRef

28.

Braga M, Frasson M, Vignali A, Zuliani W, Capretti G, Di Carlo V (2007) Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Dis Colon Rectum 50(4):464–471PubMedCrossRef

29.

Braga M, Frasson M, Vignali A, Zuliani W, Di Carlo V (2007) Open right colectomy is still effective compared to laparoscopy: results of a randomized trial. Ann Surg 246(6):1010–1014 discussion 1014–1015PubMedCrossRef

30.

Hayes JL, Hansen P (2007) Is laparoscopic colectomy for cancer cost-effective relative to open colectomy? ANZ J Surg 77(9):782–786PubMedCrossRef

31.

Ridgway PF, Boyle E, Keane FB, Neary P (2007) Laparoscopic colectomy is cheaper than conventional open resection. Colorectal Dis 9(9):819–824PubMedCrossRef

32.

Koopmann MC, Harms BA, Heise CP (2007) Money well spent: a comparison of hospital operating margin for laparoscopic and open colectomies. Surgery 142(4):546–553 discussion 553–555PubMedCrossRef

33.

Delaney CP, Chang E, Senagore AJ, Broder M (2008) Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg 247(5):819–824PubMedCrossRef

34.

Eisenberg DP, Wey J, Bao PQ, Saul M, Watson AR, Schraut WH et al (2010) Short- and long-term costs of laparoscopic colectomy are significantly less than open colectomy. Surg Endosc 24(9):2128–2134PubMedCrossRef

35.

Senagore AJ, Duepree HJ, Delaney CP, Dissanaike S, Brady KM, Fazio VW (2002) Cost structure of laparoscopic and open sigmoid colectomy for diverticular disease: similarities and differences. Dis Colon Rectum 45(4):485–490PubMedCrossRef

36.

Berto P, Lopatriello S, Aiello A, Corcione F, Spinoglio G, Trapani V et al (2012) Cost of laparoscopy and laparotomy in the surgical treatment of colorectal cancer. Surg Endosc 26(5):1444–1453PubMedCrossRef

37.

Li JC, Leung KL, Ng SS, Liu SY, Lee JF, Hon SS (2012) Laparoscopic-assisted versus open resection of right-sided colonic cancer-a prospective randomized controlled trial. Int J Colorectal Dis 27(1):95–102PubMedCrossRef

38.

Murray A, Lourenco T, de Verteuil R, Hernandez R, Fraser C, McKinley A et al (2006) Clinical effectiveness and cost-effectiveness of laparoscopic surgery for colorectal cancer: systematic reviews and economic evaluation. Health Technol Assess 10(45):1–141 iii–ivPubMed

39.

Klarenbeek BR, Coupe VM, van der Peet DL, Cuesta MA (2011) The cost effectiveness of elective laparoscopic sigmoid resection for symptomatic diverticular disease: financial outcome of the randomized control Sigma trial. Surg Endosc 25(3):776–783PubMedCrossRef

40.

Dowson HM, Huang A, Soon Y, Gage H, Lovell DP, Rockall TA (2007) Systematic review of the costs of laparoscopic colorectal surgery. Dis Colon Rectum 50(6):908–919PubMedCrossRef

41.

Duepree HJ, Senagore AJ, Delaney CP, Brady KM, Fazio VW (2002) Advantages of laparoscopic resection for ileocecal Crohn’s disease. Dis Colon Rectum 45(5):605–610PubMedCrossRef

42.

Alkhamesi NA, Martin J, Schlachta CM (2011) Cost-efficiency of laparoscopic versus open colon surgery in a tertiary care center. Surg Endosc 25(11):3597–3604PubMedCrossRef

43.

Canadian Institute for Health Information (2006) Volume I—international statistical classification of diseases and related health problems (ICD-10 CA), 10th revision. CIHI, Ottawa

44.

Ministry of Health and Long-Term Care (2006) Ontario guide to case costing. Ontario Case Costing Initiative, Ottawa

45.

American Joint Committee on Cancer (2003) AJCC cancer staging manual, 6th edn. Lippincott-Raven, Baltimore

46.

Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111(5):518–526PubMed

47.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 240(2):205–213PubMedCentralPubMedCrossRef

48.

de Groot V, Beckerman H, Lankhorst GJ, Bouter LM (2003) How to measure comorbidity. A critical review of available methods. J Clin Epidemiol 56(3):221–229PubMedCrossRef

49.

Ouellette JR, Small DG, Termuhlen PM (2004) Evaluation of Charlson-age comorbidity index as predictor of morbidity and mortality in patients with colorectal carcinoma. J Gastrointest Surg 8(8):1061–1067PubMedCrossRef

50.

Hernandez RA, de Verteuil RM, Fraser CM, Vale LD (2008) Systematic review of economic evaluations of laparoscopic surgery for colorectal cancer. Colorectal Dis 10(9):859–868PubMed

51.

Geslani M (2012) Case costing specialist, case costing department. University Health Network, Toronto

52.

Cancer Care Ontario (2012) Surgical oncology program. http://www.cancercare.on.ca/ocs/clinicalprogs/surgonc. Accessed 6 Jan 2013

53.

Royal College of Physicians and Surgeons of Canada. Objectives of training in the specialty of general surgery http://generalsurgery.utoronto.ca/Assets/GenSurgery+Digital+Assets/Education/otr.pdf. Accessed 15 Jan 2013

Title: A cost comparison of laparoscopic and open colon surgery in a publicly funded academic institution
Authors: Krista M. Hardy
Josephine Kwong
Kristen B. Pitzul
Ashley S. Vergis
Timothy D. Jackson
David R. Urbach
Allan Okrainec
Publication date: 01-04-2014
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 4/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-3311-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A cost comparison of laparoscopic and open colon surgery in a publicly funded academic institution

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2014

Accurate, safe, and rapid method of intraoperative tumor identification for totally laparoscopic distal gastrectomy: injection of mixed fluid of sodium hyaluronate and patent blue

A proposed classification for uniform endoscopic description of surgical fundoplication

Minimally invasive video-assisted thyroidectomy (MIVAT): the quest for a scarless approach

Objective analysis of surgeons’ ergonomy during laparoendoscopic single-site surgery through the use of surface electromyography and a motion capture data glove

Endoscopic submucosal dissection for gastric cancer: the influence of hospital volume on complications and length of stay

Transanal endoscopic microsurgery after endoscopic resection of malignant rectal polyps: a useful technique for indication to radical treatment