Complications, Not Minimally Invasive Surgical Technique, Are Associated with Increased Cost after Esophagectomy

Abstract

Background. Minimally invasive esophagectomy (MIE) techniques offer similar oncological and surgical outcomes to open methods. The effects of MIE on hospital costs are not well documented. Methods. We reviewed the electronic records of patients who underwent esophagectomy at a single academic institution between January 2012 and December 2014. Esophagectomy techniques were grouped into open, hybrid, MIE, and transhiatal (THE) esophagectomy. Univariate and multivariate analyses were performed to assess the impact of surgery on total hospital cost after esophagectomy. Results. 80 patients were identified: 11 THE, 11 open, 41 hybrid, and 17 MIE. Median total cost of the hospitalization was $31,375 and was similar between surgical technique groups. MIE was associated with higher intraoperative costs, but not total hospital cost. Multivariable analysis revealed that the presence of a complication, increased age, American Society of Anesthesiologists class IV (ASA4), and preoperative coronary artery disease (CAD) were associated with significantly increased cost. Conclusions. Despite the association of MIE with higher operation costs, the total hospital cost was not different between surgical technique groups. Postoperative complications and severe preoperative comorbidities are significant drivers of hospital cost associated with esophagectomy. Surgeons should choose technique based on clinical factors, rather than cost implications.

Robotic esophagectomy: the evolution of open esophagectomy to current techniques and a review of the literature

“…Others found similar findings of lower overall cost at different time points, which were also attributed to decreased postoperative costs [98,99] . Conversely, Liu et al [100] compared MIE to OE and found that, even though the postoperative costs of MIE were significantly lower, this did not offset the higher procedural expense, as was found by other authors performing similar analyses [101][102][103] .…”

The Cost of Complications Following Major Resection of Malignant Neoplasia

“…Such a wide range of costs underscores the need for value-maximization approaches that reflect the spectrum of adverse outcomes associated with surgical oncology care. 27-32 Lacking this direction, well-intended interventions can easily go astray as has been demonstrated by the early surgical pay-for-performance complication-tracking established by Medicare and other partner organizations in 2006. The resultant program which targeted surgical site infections, venous thromboembolism, myocardial infarction, pneumonia, and catheter-associated urinary tract infections has been widely-criticized for overlooking important complications relevant to both elective 10,34 and emergent 8 indications and for focusing too much on urinary complications which minimally contributed to the overall cost of care.…”

“…Thus, today, as the focus of surgical value-maximization begins to expand from its initial emphasis on colectomy and sub-specialty CABG and THA/TKA care to include a broader array of surgical procedures, 25,26 including those associated with surgical oncology, 27-32 research is needed in order to understand the impact of complications and guide the development of novel and adaptation of existing value-maximization approaches in meaningful ways. The objective of this study was to provide a framework to help achieve this end by comparing incremental costs of complications following major gastrointestinal (GI) resections for organ-specific malignant neoplasia using nationally-representative data.…”

Recent Advances in Minimally Invasive Esophagectomy

“…Better recovery and faster social reinsertion may reduce the higher surgical costs of endoscopic surgical instruments, however, in order to reduce the duration of surgery, even in classic esophagectomy, mechanical devices are used to create faster the gastric conduit or to perform the intrathoracic anastomosis. Comparative studies in the literature did not report a difference in the real cost of MIE and had included postoperative complications, which are significantly associated factors of hospital costs also in open esophagectomy (9).…”