Cost-efficiency of laparoscopic versus open colon surgery in a tertiary care center

Abstract

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. 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. 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. 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.