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Comparing cost and outcomes between peroral endoscopic myotomy and laparoscopic heller myotomy
Mikhail Attaar1, Bailey Su1, Harry J Wong1
1Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI Suite B665, Evanston, IL, 60201, United States; Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Avenue, Chicago, IL, 60637, United States.
Insights
Peroral endoscopic myotomy (POEM) offers better perioperative outcomes and is more cost-effective than laparoscopic Heller myotomy (LHM). This study found POEM led to shorter hospital stays and faster recovery.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Health Economics
Background:
- Peroral endoscopic myotomy (POEM) has been considered potentially more expensive than laparoscopic Heller myotomy (LHM).
- Comparative studies on perioperative outcomes and cost-effectiveness are crucial for surgical decision-making.
Purpose of the Study:
- To compare perioperative outcomes and hospital charges between POEM and LHM.
- To evaluate the cost-effectiveness of POEM versus LHM in a single institution.
Main Methods:
- Retrospective analysis of 33 patients undergoing LHM and 126 patients undergoing POEM.
- Exclusion of non-elective cases to ensure comparable patient cohorts.
- Analysis of operative time, length of stay, pain management, return to daily activities, and hospital charges.
Main Results:
- POEM group demonstrated significantly shorter operative times and hospital stays (p < 0.001).
- Patients undergoing POEM experienced earlier cessation of narcotics and faster return to daily living (p < 0.05).
- Adjusted for inflation, POEM incurred lower hospital charges ($30.7K ± $10.3K) compared to LHM ($35.5K ± $12.8K) (p = 0.006).
Conclusions:
- POEM is associated with significantly superior perioperative outcomes compared to LHM.
- The findings suggest that POEM may represent a more cost-effective surgical option for esophageal motility disorders.
Background:
Peroral endoscopic myotomy (POEM) has previously been shown to be equally if not more expensive than laparoscopic Heller myotomy (LHM). We compare perioperative outcomes and charges between POEM and LHM at a single institution.
Methods:
Outcomes and charge data of 33 patients who underwent LHM and 126 patients who underwent POEM were analyzed. Patients who did not present electively were excluded.
Results:
There were no demographic differences between groups. Patients who underwent POEM had a significantly shorter mean operative time and median length of stay (both p < 0.001). Patients who underwent POEM stopped narcotics earlier and had faster return to activities of daily living (both p < 0.05). When adjusted for inflation, POEM incurred less in hospital charges than LHM (35.5 ± 12.8 vs 30.7 ± 10.3 in thousands of US dollars, p = 0.006).
Conclusions:
Patients who underwent POEM compared to LHM had significantly better perioperative outcomes. Our results suggest POEM may be the more cost-effective option.
