Cost analysis of laparoscopic versus open pancreaticoduodenectomy for periampullary malignancy

Abstract

Objective: We sought to determine if laparoscopic pancreaticoduodenectomy (LPD) is a cost effective alternative to open pancreaticoduodenectomy (OPD). Methods: Itemized hospital cost data from periampullary cancer patient cohorts of LPD and OPD, previously identified as similar (met NCCN criteria for resectable disease) were compared. This review also included discharge disposition, readmission rates, and readmission costs. Results: The cohorts consisted of 52 and 50 patients in the LPD and OPD cohorts, respectively. The total OR cost was significantly higher in the LPD group (P<0.05) as the laparoscopic equipment and regional blocks had increased cost in the LPD group (P<0.05). Although hospital length of stay was shorter in the LPD group (9 vs 11.9 days), the total hospital cost (average of $36,646 for LPD vs $39,250 for OPD) was not significantly decreased compared to the OPD group. The readmission rates were equal with each group having 23 patients readmitted for a total of 43 readmissions. Readmission costs were not significantly different between groups. More LPD patients were discharged directly home, with or without home health care (P<0.05), and the number discharged to a rehabilitation facility also trended favorably in the LPD group (P=0.054). Conclusion: LPD is cost effective. Total episode-of-care costs may favor LPD via reduced post-hospital needs for skilled nursing and rehabilitation.Tabled 1LPDOPDP value(n=52)(n=50)Expired1 (2%)1 (2%)1To home (with or without HHC)46 (88%)36 (72%)0.046* To home with HHC23 (44%)23 (46%)1 To home without HHC23 (44%)13 (26%)0.064To long term acute care0 (0%)2 (4%)0.24To rehabilitation center0 (0%)4 (8%)0.054To skilled nursing facility5 (10%)7 (14%)0.55Laparoscopic equipment (SEM)$ 450 (31)$ 46 (17)<0.01*Regional block (SEM)$ 1,450 (144)$ 820 (103)<0.01*OR (SEM)$ 13,173 (254)$ 11,770 (539)0.02*Total number of readmissions4343Total hospital days during readmissions282408Average number of readmissions per patient (SEM)0.83 (0.20)0.86 (0.19)0.9Average number of hospital days per patient (SEM)5.42 (1.57)8.16 (2.24)0.28Total readmission costs (SEM)$ 14,722 (2663)$ 20,096 (5983)0.42P values were calculated using Fisher's exact test and unpaired t test.HHC home health care, SEM standard error of the mean. Open table in a new tab P values were calculated using Fisher's exact test and unpaired t test. HHC home health care, SEM standard error of the mean.