PMU3 An Economic Model for Surgical Complication Treatment Costs Among Patients Undergoing Selected Major Surgeries Performed in Open Versus Laparoscopic Approach

Abstract

To develop an economic model of surgical complication treatment costs for open versus laparoscopic colorectal, thoracic, hepatopancreatobiliary, and gynecological procedures. The economic model was developed to estimate costs incurred to treat complications from lower anterior resection, left and right colectomies, pancreatectomy, hepatectomy, thoracic lobectomy and wedge resection, and hysterectomy. Model inputs for complication rates and incremental costs of treating such complications were derived from literature published between 2008 and 2018. Complications examined include surgical site infection and bleeding as well as procedure-specific complications, such as anastomotic leak (colorectal surgeries), obstruction (hysterectomy), and air leak (thoracic surgeries); rates and costs associated with inpatient readmissions were also included. Expected per-patient cost to treat each complication for the open and laparoscopic groups was calculated by multiplying the complication incidence rate by estimated incremental cost associated with treating the complication; the sum of these values represented the total per-patient expected complication treatment costs. Complication treatment cost was up to 56 percent lower when the surgery was performed laparoscopically as compared with open for all procedures except for pancreatectomy. As compared with open surgeries, laparoscopic surgeries were associated with lower total complication treatment costs for the following procedures: inpatient hysterectomy ($1231.39 vs. $535.91), outpatient hysterectomy ($312.43 vs. $138.41), hepatectomy ($8966.37 vs. $4700.68), left colectomy ($4952.3 vs. $2852.46), right colectomy ($5016.71 vs. $3031.89), lower anterior resection ($5444.77 vs. $3235.85), thoracic wedge resection ($5246.62 vs. $3147.18), and thoracic lobectomy ($3833.88 vs. $2736.89). For pancreatectomy, complication treatment cost for open surgery was lower than that of laparoscopic surgery by 11 percent ($11710.27 vs. $13038.17). Compared to open surgery, laparoscopic surgery was associated with cost savings in complication treatments for hysterectomy, hepatectomy, colectomy, lower anterior resection, and thoracic lobectomy and wedge resection.