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A national evaluation of clinical and economic outcomes in open versus laparoscopic colorectal surgery.
Surg Endosc 2016; 30(10):4220-8SE

Abstract

BACKGROUND

Surgical value is based on optimizing clinical and financial outcomes. The clinical benefits of laparoscopic surgery are well established; however, many patients are still not offered a laparoscopic procedure. Our objective was to compare the modern clinical and financial outcomes of laparoscopic and open colorectal surgery.

METHODS

The Premier Perspective database identified patients undergoing elective colorectal resections from January 1, 2013 to December 31, 2013. Cases were stratified by operative approach into laparoscopic and open cohorts. Groups were controlled on all demographics, diagnosis, procedural, hospital characteristics, surgeon volume, and surgeon specialty and then compared for clinical and financial outcomes. The main outcome measures were length of stay (LOS), complications, readmission rates, and cost by surgical approach.

RESULTS

A total of 6343 patients were matched and analyzed in each cohort. The most common diagnosis was diverticulitis (p = 0.0835) and the most common procedure a sigmoidectomy (p = 0.0962). The LOS was significantly shorter in laparoscopic compared to open (mean 5.78 vs. 7.80 days, p < 0.0001). The laparoscopic group had significantly lower readmission (5.82 vs. 7.68 %, p < 0.0001), complication (32.60 vs. 42.28 %, p < 0.0001), and mortality rates (0.52 vs. 1.28 %, p < 0.0001). The total cost was significantly lower in laparoscopic than in open (mean $17,269 vs. $20,552, p < 0.0001). By category, laparoscopy was significantly more cost-effective for pharmacy (p < 0.0001), room and board (p < 0.0001), recovery room (p = 0.0058), ICU (p < 0.0001), and laboratory and imaging services (both p < 0.0001). Surgical supplies (p < 0.0001), surgery (p < 0.0001), and anesthesia (p = 0.0053) were higher for the laparoscopic group.

CONCLUSIONS

Laparoscopy is more cost-effective and produces better patient outcomes than open colorectal surgery. Minimally invasive colorectal surgery is now the standard that should be offered to patients, providing value to both patient and provider.

Authors+Show Affiliations

Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA. debby_keller@hotmail.com. Division of Colon and Rectal Surgery, Houston Methodist Hospital, Houston, TX, USA. debby_keller@hotmail.com.University Hospitals-Case Medical Center, Cleveland, OH, USA.Healthcare Outcomes and Research, Covidien, Mansfield, MA, USA.Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA. Division of Colon and Rectal Surgery, Houston Methodist Hospital, Houston, TX, USA. Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26715021

Citation

Keller, Deborah S., et al. "A National Evaluation of Clinical and Economic Outcomes in Open Versus Laparoscopic Colorectal Surgery." Surgical Endoscopy, vol. 30, no. 10, 2016, pp. 4220-8.
Keller DS, Delaney CP, Hashemi L, et al. A national evaluation of clinical and economic outcomes in open versus laparoscopic colorectal surgery. Surg Endosc. 2016;30(10):4220-8.
Keller, D. S., Delaney, C. P., Hashemi, L., & Haas, E. M. (2016). A national evaluation of clinical and economic outcomes in open versus laparoscopic colorectal surgery. Surgical Endoscopy, 30(10), pp. 4220-8. doi:10.1007/s00464-015-4732-6.
Keller DS, et al. A National Evaluation of Clinical and Economic Outcomes in Open Versus Laparoscopic Colorectal Surgery. Surg Endosc. 2016;30(10):4220-8. PubMed PMID: 26715021.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A national evaluation of clinical and economic outcomes in open versus laparoscopic colorectal surgery. AU - Keller,Deborah S, AU - Delaney,Conor P, AU - Hashemi,Lobat, AU - Haas,Eric M, Y1 - 2015/12/29/ PY - 2015/07/01/received PY - 2015/12/15/accepted PY - 2015/12/31/entrez PY - 2015/12/31/pubmed PY - 2017/7/21/medline KW - Financial analysis KW - Laparoscopic colorectal surgery KW - Patient outcomes KW - Surgical quality SP - 4220 EP - 8 JF - Surgical endoscopy JO - Surg Endosc VL - 30 IS - 10 N2 - BACKGROUND: Surgical value is based on optimizing clinical and financial outcomes. The clinical benefits of laparoscopic surgery are well established; however, many patients are still not offered a laparoscopic procedure. Our objective was to compare the modern clinical and financial outcomes of laparoscopic and open colorectal surgery. METHODS: The Premier Perspective database identified patients undergoing elective colorectal resections from January 1, 2013 to December 31, 2013. Cases were stratified by operative approach into laparoscopic and open cohorts. Groups were controlled on all demographics, diagnosis, procedural, hospital characteristics, surgeon volume, and surgeon specialty and then compared for clinical and financial outcomes. The main outcome measures were length of stay (LOS), complications, readmission rates, and cost by surgical approach. RESULTS: A total of 6343 patients were matched and analyzed in each cohort. The most common diagnosis was diverticulitis (p = 0.0835) and the most common procedure a sigmoidectomy (p = 0.0962). The LOS was significantly shorter in laparoscopic compared to open (mean 5.78 vs. 7.80 days, p < 0.0001). The laparoscopic group had significantly lower readmission (5.82 vs. 7.68 %, p < 0.0001), complication (32.60 vs. 42.28 %, p < 0.0001), and mortality rates (0.52 vs. 1.28 %, p < 0.0001). The total cost was significantly lower in laparoscopic than in open (mean $17,269 vs. $20,552, p < 0.0001). By category, laparoscopy was significantly more cost-effective for pharmacy (p < 0.0001), room and board (p < 0.0001), recovery room (p = 0.0058), ICU (p < 0.0001), and laboratory and imaging services (both p < 0.0001). Surgical supplies (p < 0.0001), surgery (p < 0.0001), and anesthesia (p = 0.0053) were higher for the laparoscopic group. CONCLUSIONS: Laparoscopy is more cost-effective and produces better patient outcomes than open colorectal surgery. Minimally invasive colorectal surgery is now the standard that should be offered to patients, providing value to both patient and provider. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/26715021/A_national_evaluation_of_clinical_and_economic_outcomes_in_open_versus_laparoscopic_colorectal_surgery_ L2 - https://dx.doi.org/10.1007/s00464-015-4732-6 DB - PRIME DP - Unbound Medicine ER -