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Cost-efficiency of laparoscopic versus open colon surgery in a tertiary care center
Nawar A Alkhamesi1, Janet Martin, Christopher M Schlachta
1Canadian Surgical Technologies and Advance Robotics, London Health Science Centre, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, 339 Windermere Road, PO Box 5339, London, ON N6A 5A5, Canada.
Background:
Real-world cost analysis of elective laparoscopic versus open colon resection in a tertiary Canadian teaching hospital was performed to evaluate the financial impact of minimally invasive surgery with the appointment of an experienced laparoscopic surgeon in a single-payer system.
Methods:
A retrospective review of elective laparoscopic and open segmental colectomies (2005-2010) was performed. Combined cases and procedures performed for inpatients were excluded to minimize cost variation. The hospital case-costing system was used to calculate the hourly cost of operating room time and the daily hospital ward stay. The cost of disposable equipment was calculated manually. A cost-minimization analysis was performed from the hospital perspective, which excludes physician payment. Cases were analyzed on an intention-to-treat basis.
Results:
For this study, 470 right-side colectomies (322 open and 148 laparoscopic) and 266 left-side colectomies (181 open and 85 laparoscopic) were found to match the inclusion criteria. The operating room time was longer for the laparoscopic procedures than for the open procedures: 203.4 versus 173.4 min (P = 0.1) for right and extended right hemicolectomy (RC) and 287.4 versus 173.4 min (P = 0.009) for left and sigmoid colectomy (LC). This resulted in higher operating room costs: $4,094.10 versus $3312.11 for RC and $5,784.88 versus $4,582.55 for LC. The median hospital stay for an index admission was shorter for both sides: 5 days versus 8 days (P = 0.01) for RC and 4 days versus 6 days (P = 0.04). This resulted in lower ward costs: $4,556.07 versus $6,632.82 for RC and $3,297.24 versus $5,949.09 for LC. The cost of care per index admission after laparoscopic versus open resection was $10,097.93 versus $10,444.69 for RC and $11,067.72 versus. $11,146.56 for LC. The introduction of laparoscopic surgery has saved our institution $58,021.43 over 5 years.
Conclusion:
The reasons for observed differences in operating room time and length of hospital stay were uncontrolled and may be multifactorial. However, the results demonstrate that adopting a laparoscopic approach for elective colon surgery resulted in progressive financial savings.
