Cost-effectiveness of mini-laparotomy in patients with colorectal cancers: A propensity scoring matching approach

Abstract

ObjectiveSurgical technique process innovations are expected to generally incur no additional cost but gain better quality. Whether a mini-laparotomy surgery (MLS) in the treatment of colorectal cancer (CRC) is more cost effective than conventional open surgery had not been well examined. The objective of this study was to apply cost-effectiveness approaches to investigate the cost effectiveness of adopting MLS compared with open surgery 1 year following resection in CRC patients.Research designA prospective non-randomized cohort study designSettingAn academic medical centerParticipantsA total of 224 patients who received elective MLS and 339 who received conventional surgery; after propensity score matching, 212 pairs were included for analysis.InterventionNoneMain outcome measuresCost measures were hospital-index cost and outpatient and inpatient costs within 1 year after discharge. Effectiveness measures were life-years (LYs) gained and quality-adjusted life-year (QALYs) gained.Statistical methodsWe calculated incremental costs and effectiveness by differences in these values between MLS and conventional surgery using adjusted predicted estimates.ResultsMLS patients had lower rates of blood transfusions, less complication, and shorter post-surgical lengths of stay and more medical cost savings. One-year overall medical costs for MLS patients were TWD 748,269 (USD 24,942) per QALY gained, significant lower than for the comparison group (p-value = 0.045).ConclusionOur findings supported that the less invasive surgical process through MLS not only saved medical costs, but also increased QALYs for surgical treatment in CRC patients.

Abdominal wound length influences the postoperative serum level of interleukin-6 and recovery of flatus passage among patients with colorectal cancer

“…In recent years, an increasing number of studies have reported the clinical benefits of mini-laparotomies for colorectal cancer resection. Different authors defined a mini-laparotomy as an abdominal wound length either less than 7 or 8 cm (17)(18)(19)(20). Regardless of the mild difference in wound length, the minilaparotomy was significantly associated with earlier recovery of flatus passage than a conventional laparotomy (17,20).…”

“…Regardless of the mild difference in wound length, the mini-laparotomy was significantly associated with earlier recovery of flatus passage than a conventional laparotomy ( 17 , 20 ). A recent case-controlled study comparing the medical costs of a mini-laparotomy (less than 8 cm) and a conventional laparotomy in patients with colorectal cancer reported that the mini-laparotomy is more cost-effective because of fewer complications and a shorter post-operative hospital stay ( 19 ). Thus far, the biological mechanism underlying the benefits of mini-laparotomy abdominal wounds on the earlier recovery of flatus passage or shorter hospital stay remains to be investigated.…”

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“…Regardless of the mild difference in wound length, the minilaparotomy was significantly associated with earlier recovery of flatus passage than a conventional laparotomy (17,20). A recent case-controlled study comparing the medical costs of a minilaparotomy (less than 8 cm) and a conventional laparotomy in patients with colorectal cancer reported that the mini-laparotomy is more cost-effective because of fewer complications and a shorter post-operative hospital stay (19). Thus far, the biological mechanism underlying the benefits of mini-laparotomy abdominal wounds on the earlier recovery of flatus passage or shorter hospital stay remains to be investigated.…”