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Hand-assisted laparoscopic colectomy versus standard laparoscopic colectomy: a cost analysis.
A C Roslani1, D C Koh, C B Tsang
1Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore.
Summary
Hand-assisted laparoscopic colectomy (HALC) offers shorter operative times and fewer complications than standard laparoscopic colectomy (SLC). Despite higher direct costs, HALC does not significantly increase overall institutional costs, making it a comparable option.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Surgery
- Health Economics
Background:
- Limited literature compares hand-assisted laparoscopic colectomy (HALC) with standard laparoscopic colectomy (SLC).
- HALC may offer benefits like reduced operative times and conversion rates, but concerns exist regarding increased inflammatory response, larger incisions, and higher direct costs.
- Existing studies lack detailed cost comparisons, necessitating further investigation into the economic implications of HALC versus SLC.
Purpose of the Study:
- To compare the institutional costs of hand-assisted laparoscopic colectomy (HALC) with standard laparoscopic colectomy (SLC).
- To evaluate whether HALC incurs significantly higher institutional costs compared to standard laparoscopic techniques.
- To provide a detailed cost comparison between HALC and SLC.
Main Methods:
- Retrospective review of patients undergoing SLC or HALC between August 2004 and September 2006.
- Assessment of clinical outcomes including operative times, conversion rates, pain scores, ileus resolution, length of stay, and complications.
- Calculation of total institutional costs from the day of surgery, with statistical analysis using chi(2), Fisher's exact test, Mann-Whitney U-test, or nonparametric bootstrapping.
Main Results:
- Seventy-three patients underwent SLC and 101 underwent HALC, with similar demographics and indications (primarily colorectal cancers).
- HALC was associated with shorter operative times (147.5 vs 172.5 min, P < 0.05) and lower complication rates (28.7% vs 45.2%, P < 0.025).
- While operative and consumable costs were higher for HALC, total institutional costs did not differ significantly (US$8999.8 for HALC vs US$7910.7 for SLC, P = 0.11).
Conclusions:
- Hand-assisted laparoscopic colectomy (HALC) does not result in significantly higher institutional costs compared to standard laparoscopic colectomy (SLC).
- The findings suggest that HALC is a cost-effective alternative to SLC when considering overall institutional expenditure.
- Despite higher direct costs for consumables and operative procedures, the comparable total costs support the use of HALC.
