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A financial analysis of pediatric laparoscopic versus open fundoplication
Daniel J Ostlie1, Shawn D St Peter, Charles L Snyder
1Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri 64108, USA.
Insights
Laparoscopic fundoplication (LF) offers comparable total costs to open fundoplication (OF) for GER in children. LF shows benefits in shorter hospital stays and earlier feeding times, despite longer operating times.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Minimally invasive surgery
Background:
- Laparoscopic fundoplication (LF) is increasingly preferred over open fundoplication (OF) for treating symptomatic gastroesophageal reflux (GER) in pediatric patients.
- This study aimed to compare clinical and financial outcomes between LF and OF.
Purpose of the Study:
- To evaluate the clinical efficacy and financial implications of laparoscopic fundoplication versus open fundoplication in pediatric patients.
- To determine if one surgical approach offers superior outcomes in terms of patient recovery and cost-effectiveness.
Main Methods:
- A retrospective review of 100 consecutive pediatric patients undergoing elective LF or OF between 2003 and 2004.
- Analysis of clinical data including length of stay (LOS), operating time (OT), and time to initial (IF) and full (FF) feedings.
- Comparison of financial charges across various categories: anesthesia, central supply, equipment, operating suite, hospital room, and pharmacy.
Main Results:
- Patients in both groups were well-matched for age, gender, and weight.
- Laparoscopic fundoplication (LF) demonstrated significantly shorter LOS (1.2 vs. 2.9 days), earlier IF (7.3 vs. 27.9 hours) and FF (21.8 vs. 42.9 hours), and lower equipment, hospital room, and pharmacy charges.
- Open fundoplication (OF) showed shorter OT (77 vs. 91 minutes) and lower anesthesia, central supply, and operating suite charges.
- Total charges were statistically similar between LF ($11,449) and OF ($11,632).
Conclusions:
- Despite variations in individual cost categories, the overall financial burden of LF and OF for pediatric GER is comparable.
- The longer operating time associated with LF is offset by significant financial advantages, including reduced hospital stays and earlier patient feeding.
- LF may offer benefits in terms of patient recovery and comfort, as suggested by lower pharmacy charges potentially related to pain management.
Introduction:
Laparoscopic fundoplication (LF) is rapidly replacing open fundoplication (OF) for correcting symptomatic gastroesophageal reflux (GER) in infants and children. In this study, we compared various clinical and financial parameters to determine if one technique is superior.
Methods:
With Institutional Review Board approval, charts and charge data for 50 consecutive patients undergoing elective LF or OF were reviewed in 2003 and 2004 (n = 100). Clinical variables evaluated included gender, age, weight, length of stay (LOS), operating time (OT), and time to initial (IF) and full (FF) feedings. Financial charges that were reviewed included anesthesia, central supply and sterilization, equipment, operating suite, hospital room and board, pharmacy, and total charges.
Results:
The groups were equally matched in relation to gender, age, and weight. The table below illustrates the statistically significant differences (P < 0.05) between the groups. Favoring LNF LOS (1.2 vs. 2.9 days) IF (7.3 vs. 27.9 hours) FF (21.8 vs. 42.9 hours) Equipment ($1,006 vs. $1,609) Hospital Room ($1,290 vs. $2,847) Pharmacy ($180 vs. $461), Favoring OF OT (77 vs. 91 minutes) Anesthesia ($389 vs. $475) Central Supply and Sterilization ($1,367 vs. $2,515) Operating Suite ($4,058 vs. $5,142) Total charges were similar (LF, $11,449; OF, $11,632).
Conclusions:
Interestingly, although there were statistical differences in every charge category, total charges for LF and OF did not differ significantly. Thus, traditionally higher expenses from longer OT for LF seem to be offset by financial benefits, such as shorter LOS, reduced discomfort as evidenced by lower narcotic charges, and earlier IF/FF.
