Cost analysis of laparoscopic versus open colectomy in patients with colon cancer: Results from a large nationwide population database

Department of Surgery, York Hospital, York, Pennsylvania, USA.
The American surgeon (Impact Factor: 0.92). 06/2012; 78(6):635-41.
Source: PubMed

ABSTRACT Laparoscopic colectomy (LC) is a safe and reliable option for patients with colon cancer. This study examined factors associated with LC use and cost differences between LC and open colectomy (OC). Using the Cost & Utilization Project National Inpatient Sample database (2008), patients with colon cancer undergoing elective LC or OC were selected. Chi square and Mann-Whitney tests were used to assess differences between LC and OC. Logistic and multiple regression analysis was used to determine variables associated with LC and predictors of cost. All analysis was weighted. A total of 63,950 patients were identified (LC 8.1%, OC 91.9%). The majority was female (52.7%), white (61.4%), using Medicare (61.1%), and had surgery performed at a large (64.2%), nonteaching (56.9%), urban (87.3%) hospital in the South (37.7%). Mean age was 70 years. On unadjusted analysis, LC was associated with a lower mortality rate (1.7 vs 2.4%), fewer complications (18.9 vs 27.1%), shorter length of stay (5 vs 7 days), and lower total charges ($41,971 vs $43,459, all P < 0.001). LC is a less expensive but less popular surgical option for colon cancer. Stage, race, Charlson score, teaching status, location, and hospital size influence the use of a laparoscopic approach. LC is associated with fewer complications and decreased mortality which contribute to its lower cost as compared with OC.

  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Postoperative complications increase patient morbidity and mortality and are a target for quality improvement programs. The goal of this study was to review the world's literature on postoperative complications in general surgery patients and try to examine the effect of these complications on patient-centered outcomes. METHODS: A comprehensive search of the current literature identified 18 studies on the topic of postoperative complications in general surgery patients. RESULTS: Postoperative complications are common in general surgery patients and contribute to increased mortality, length of stay, and need for an increased level of care at discharge (decline in disposition). CONCLUSIONS: Although the concept of patient-centered outcomes is not new, it has not been applied to postoperative complications. It is likely that the effect of complications on length of hospital stay and postoperative discharge reflects an impact of complications on these patient-centered outcomes. Future studies should consider the effect of complications on those outcomes that are most important to the individual patient.
    Journal of Surgical Research 02/2013; 181(1). DOI:10.1016/j.jss.2013.01.032 · 2.12 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: What will the future hold for minimally invasive colorectal surgery? Colorectal surgeons have been at the forefront of technological progress of this field dating back to the development of endoscopic polypectomy. Progress in laparoscopic and natural orifice transluminal endoscopic surgeries has pointed toward the path to the future. Endoluminal surgery—operating within the lumen of the colon and rectum—exists in the transanal endoscopic microsurgery experience. Transluminal surgery—operating in the abdomen through the wall of another organ—is ideally suited to the colorectum, where the organ of access is also the target organ for surgery. Herein, developments in transluminal surgery are presented along with an outline of challenges and developing solutions, including needlescopic surgery, miniaturized robotics, and the role of magnets. These advancements follow a natural progress of development and are in an early stage but promise an exciting future for colorectal surgery.
    Seminars in Colon [amp ] Rectal Surgery 03/2013; 24(1):61–65. DOI:10.1053/j.scrs.2012.10.014
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Prolonged operative duration is associated with increased postoperative morbidity and mortality. Although laparoscopic colectomy (LC) is associated with longer operative duration compared with open colectomy (OC), research shows paradoxically decreased morbidity following LC versus OC. The direct impact of operative duration on postoperative pulmonary complications (PPC) following LC versus OC has not been analyzed. METHODS: We queried the ACS/NSQIP 2009-2010 Public Use File for patients who underwent elective LC and OC. The associations between operative duration and a PPC (pneumonia, intubation >48 h, and unplanned intubation) were evaluated. Multivariable regression models were created to determine the independent effect of operative time on the development of PPC controlling for LC versus OC. RESULTS: A total of 25,419 colectomies (13,741 laparoscopic and 11,678 open) were reviewed; 765 (3 %) patients experienced at least one PPC. Regression modeling demonstrated that for both LC and OC each 60-min increase in operative time up to 480 min was associated with 13 % increased odds of PPC [odds ratio (OR) 1.13; 95 % confidence interval (CI) 1.07-1.19]. Beyond 480 min, each additional 60-min interval was associated with 33 % increased risk of PPC (OR 1.33; 95 % CI 1.12-1.58). Overall, PPCs occurred half as often following LC [270 (2 %) laparoscopic vs. 497 (4.3 %) open; OR 0.45; 95 % CI 0.39-0.53]. CONCLUSIONS: Operative duration is independently associated with increased risk of PPC in patients undergoing LC and OC. However, a laparoscopic approach carries half the absolute risk of PPC and, when safe, should be preferentially utilized despite a potential for prolonged operative duration.
    Surgical Endoscopy 04/2013; 27(10). DOI:10.1007/s00464-013-2949-9 · 3.31 Impact Factor
Show more