A national database propensity score-matched comparison of minimally invasive and open colectomy for long-term opioid use

Bastawrous, Amir L.; Brockhaus, Kara; Chang, Melissa I.; Milky, Gediwon; Shih, I‐Fan; Li, Yanli; Cleary, Robert K.

doi:10.1007/s00464-021-08338-9

Cited by 10 publications

(15 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Laparoscopy and other minimally invasive surgery (MIS) options reduce operative trauma to the abdominal wall, reducing postoperative pain, analgesia use [ 41 ], improving LOS, as well as decreasing rates of readmission and reoperation [ 42 ]. It is unsurprising that MIS techniques have become the cornerstone of colorectal ERAS and SDD protocols.…”

Section: Discussionmentioning

confidence: 99%

Same-day discharge (SDD) vs standard enhanced recovery after surgery (ERAS) protocols for major colorectal surgery: a systematic review

Zheng

Wee

Abdullah

et al. 2023

Int J Colorectal Dis

View full text Add to dashboard Cite

Background Enhanced recovery after surgery (ERAS) programs are well-established, resulting in improved outcomes and shorter length of hospital stay (LOS). Same-day discharge (SDD), or “hyper-ERAS”, is a natural progression of ERAS. This systematic review aims to compare the safety and efficacy of SDD against conventional ERAS in colorectal surgery. Methods The protocol was prospectively registered in PROSPERO (394793). A systematic search was performed in major databases to identify relevant articles, and a narrative systematic review was performed. Primary outcomes were readmission rates and length of hospital stay (LOS). Secondary outcomes were operative time and blood loss, postoperative pain, morbidity, nausea or vomiting, and patient satisfaction. Risks of bias was assessed using the ROBINS-I tool. Results Thirteen studies were included, with five single-arm and eight comparative studies, of which one was a randomised controlled trial. This comprised a total of 38,854 patients (SDD: 1622; ERAS: 37,232). Of the 1622 patients on the SDD pathway, 1590 patients (98%) were successfully discharged within 24 h of surgery. While most studies had an overall low risk of bias, there was considerable variability in inclusion criteria, types of surgery or anaesthesia, and discharge criteria. SDD resulted in a significantly reduced postoperative LOS, without increasing risk of 30-day readmission. Intraoperative blood loss and postoperative morbidity rates were comparable between both groups. Operative duration was shorter in the SDD group. Patient-reported satisfaction was high in the SDD cohort. Conclusion SDD protocols appear to be safe and feasible in selected patients undergoing major colorectal operations. Randomised controlled trials are necessary to further substantiate these findings.

show abstract

Section: Discussionmentioning

confidence: 99%

Same-day discharge (SDD) vs standard enhanced recovery after surgery (ERAS) protocols for major colorectal surgery: a systematic review

Zheng

Wee

Abdullah

et al. 2023

Int J Colorectal Dis

View full text Add to dashboard Cite

show abstract

“…In addition, RS patients had shorter mean index hospital LOS, lower conversion-to-open surgery rates and less mean hospital outpatient visits after surgery when compared to the LS group. These findings likely reflect long-term MIS colectomy benefits that include faster recovery with fewer complications and less pain [ 1 – 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…To be eligible for data analysis, patients were required to be continuously enrolled with medical and prescription drug coverage from 180 days prior to and 365 days after inpatient colectomy. Exclusion criteria included: (1) emergent cases; (2) inpatient cases that were not coded with diagnosis-related group (DRG) codes 329, 330 or 331; (3) demographic information missing; (4) discharges with extreme total payment in index hospitalization (< 1st or > 99th); (5) patients with capitated payment insurance plans (health maintenance organization and capitated point-of-service) because these plans often submit claims with $0 pay value. Emergent cases were defined as patients who had an emergency room service claim found on the day of admission.…”

Section: Study Populationmentioning

confidence: 99%

“…The development and introduction of minimally invasive surgery (MIS) tools and approaches have fundamentally changed colorectal surgery. MIS approaches to colorectal surgery offer several outcomes advantages over traditional open surgery (OS) that include earlier return of bowel function, less postoperative pain and opioid use, shorter hospital length of stay (LOS), and fewer surgical site infections [1][2][3][4][5]. The adoption of the MIS approach to colorectal surgery increased from 40 to 60% in 2011 to 75% in 2018 [6].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Comparison of health-care utilization and expenditures for minimally invasive vs. open colectomy for benign disease

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background Adoption of minimally invasive approaches continues to increase, and there is a need to reassess outcomes and cost. We aimed to compare open versus minimally invasive colectomy short- and long-term health-care utilization and payer/patient expenditures for benign disease. Methods This is a retrospective analysis of IBM® MarketScan® Database patients who underwent left or right colectomy for benign disease between 2013 and 2018. Outcomes included total health-care expenditures, resource utilization, and direct workdays lost up to 365 days following colectomy. The open surgical approach (OS) was compared to minimally invasive colectomy (MIS) with subgroup analysis of laparoscopic (LS) and robotic (RS) approaches using inverse probability of treatment weighting. Results Of 10,439 patients, 2531 (24.3%) had open, 6826 (65.4%) had laparoscopic, and 1082 (10.3%) had robotic colectomy. MIS patients had shorter length of stay (LOS; mean difference, − 1.71, p < 0.001) and lower average total expenditures (mean difference, − $2378, p < 0.001) compared with open patients during the index hospitalization. At 1 year, MIS patients had lower readmission rates, and fewer mean emergency and outpatient department visits than open patients, translating into additional savings of $5759 and 2.22 fewer days missed from work for health-care visits over the 365-day post-discharge period. Within MIS, RS patients had shorter LOS (mean difference, − 0.60, p < 0.001) and lower conversion-to-open rates (odds ratio, 0.31 p < 0.001) during the index hospitalization, and lower hospital outpatient visits (mean difference, − 0.31, p = 0.001) at 365 days than LS. Conclusion MIS colectomy is associated with lower mean health-care expenditures and less resource utilization compared to the open approach for benign disease at index operation and 365-days post-discharge. Health-care expenditures for LS and RS are similar but shorter mean LOS and lower conversion-to-open surgery rates were observed at index operation for the RS approach.

show abstract

“…Furthermore longer-term clinical and economic outcomes were not evaluated. Evidence from other specialties would suggest that the robotic approach has advantages in terms of decreased long-term opiate use, and faster return to work [22][23][24]. Factors such as these were not considered in this analysis.…”

Section: Discussionmentioning

confidence: 99%

Is robotic lobectomy cheaper? A micro-cost analysis

Shanahan

Kreaden

Sørensen³

et al. 2022

J Robotic Surg

View full text Add to dashboard Cite

Higher capital costs and operating room costs associated with Lobectomy via Robot Assisted Thoracic Surgery (RATS) have previously been suggested as the principal contributors to the elevated overall cost. This study uses a micro-costing approach to a previous analysis of clinical outcomes of RATS, Video-Assisted Thoracic Surgery (VATS) and Open Lobectomy to evaluate the most significant cost drivers for the higher cost of robot-assisted lobectomy. A micro-costing model was developed to reflect the pathway of patients from day of surgery through the first 30 days following lobectomy. Costs were provided for RATS, VATS and Open approaches. Sensitivity analysis was performed specifically in the area of staff costs. A threshold sensitivity analysis of the overall cost components was also performed. Total cost per case for the RATS approach was €13,321 for the VATS approach €11,567, and for the Open approach €12,582. The overall cost differences were driven primarily by the elevated consumable costs associated with RATS Lobectomy. Capital costs account for a relatively small proportion of the per-case cost difference. This study presents a detailed analysis of the cost drivers for lobectomy, modelled for the three primary surgical approaches. We believe this is a useful tool for surgeons, hospital management, and service commissioning agencies to accurately and comprehensively determine where cost savings can be applied in their programme to improve the cost-effectiveness of RATS lobectomy.

show abstract

A national database propensity score-matched comparison of minimally invasive and open colectomy for long-term opioid use

Cited by 10 publications

References 30 publications

Same-day discharge (SDD) vs standard enhanced recovery after surgery (ERAS) protocols for major colorectal surgery: a systematic review

Same-day discharge (SDD) vs standard enhanced recovery after surgery (ERAS) protocols for major colorectal surgery: a systematic review

Comparison of health-care utilization and expenditures for minimally invasive vs. open colectomy for benign disease

Is robotic lobectomy cheaper? A micro-cost analysis

Contact Info

Product

Resources

About