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Minimally invasive distal pancreatectomy and the cost of conversion
Camille L Stewart1, Paul Wong1, Luke Selby2
1Department of Surgery, City of Hope, Duarte, California.
Background:
Minimally invasive surgery (MIS) is preferred for distal pancreatectomy but is not always attempted due to the risk of conversion to open. We hypothesized that the total cost for MIS converted to open procedures would be comparable to those that started open.
Methods:
A prospectively collected institutional registry (2011-2017) was reviewed for demographic, clinical, and perioperative cost data for patients undergoing distal pancreatectomy.
Results:
There were 80 patients who underwent distal pancreatectomy: 41 open, 39 MIS (11 laparoscopic and 28 robotic). Conversion to open occurred in 14 of 39 (36%, 3 laparoscopic and 11 robotic). Length of stay was shorter for the MIS completed (6 days; range, 3-8), and MIS converted to open (7 days; range, 4-10) groups, compared with open (10 days; range, 5-36; P = .003). Laparoscopic cases were the least expensive (P = .02). Robotic converted to open procedures had the highest operating room cost. However, the total cost for robotic converted to open cohort was similar to the open cohort due to cost savings associated with a shorter length of stay.
Conclusions:
Despite the higher intraoperative costs of robotic surgery, there is no significant overall financial penalty for conversion to open. Financial considerations should not play a role in selecting a robotic or open approach.
Insights
Minimally invasive surgery (MIS) for distal pancreatectomy, even with conversion to open procedures, has comparable total costs to open surgery. Financial factors should not influence the choice between robotic or open approaches.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Health Economics
Background:
- Minimally invasive surgery (MIS) is preferred for distal pancreatectomy but conversion to open surgery can deter its use.
- This study investigates the economic implications of converting MIS distal pancreatectomy to open procedures.
Purpose of the Study:
- To compare the total costs of distal pancreatectomy procedures, analyzing open surgery versus minimally invasive surgery (MIS) with and without conversion to open.
- To determine if the risk of conversion impacts the overall financial viability of MIS.
Main Methods:
- A review of a prospectively collected institutional registry from 2011-2017 for patients undergoing distal pancreatectomy.
- Data collected included demographic, clinical, and perioperative cost information.
- Analysis compared costs across open, completed MIS (laparoscopic and robotic), and converted MIS to open groups.
Main Results:
- Of 80 distal pancreatectomy patients, 41 underwent open surgery and 39 underwent MIS (11 laparoscopic, 28 robotic).
- Conversion to open occurred in 36% of MIS cases (14/39).
- MIS groups (completed and converted) had shorter lengths of stay than open surgery (P=.003). Laparoscopic cases were least expensive (P=.02). Robotic conversions had higher OR costs but similar total costs to open surgery due to shorter hospital stays.
Conclusions:
- Higher intraoperative costs associated with robotic surgery do not result in a significant overall financial penalty, even with conversion to open.
- Financial considerations should not be a barrier to choosing between robotic or open approaches for distal pancreatectomy.
