Effect of Laparoscopic Surgery on Health Care Utilization and Costs in Patients Who Undergo Colectomy

Crawshaw, Benjamin P.; Chien, Hung Lun; Augestad, Knut Magne; Delaney, Conor P.

doi:10.1001/jamasurg.2014.3171

Cited by 76 publications

(40 citation statements)

References 12 publications

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“…Our data supports a growing body of literature that minimally invasive procedures may be associated with increased OR cost but are potentially overall cost saving when other variables are considered [4, 15, 16]. This study corroborates those findings in that we also found that MIE was associated with longer and more expensive operations but was not associated with increased total hospital cost.…”

Section: Discussionsupporting

confidence: 91%

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

Ginsberg

et al. 2016

Minimally Invasive Surgery

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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.

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Section: Discussionsupporting

confidence: 91%

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

Ginsberg

et al. 2016

Minimally Invasive Surgery

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“…Both of these resource use variables may give rise to rare but extreme costs, which can influence the entire result of the study and single-handedly tip the result in one direction, especially if the study contains few patients as is the case here 15 . It was reported recently that patients who underwent open colectomy were absent from work on average 2⋅75 days more than those who had laparoscopic surgery 28 . Based on these results, if sick leave costs were included, it is likely that Hartmann's procedure would be even more costly than laparoscopic lavage.…”

Section: Discussionmentioning

confidence: 97%

Health economic analysis of laparoscopic lavage versus Hartmann's procedure for diverticulitis in the randomized DILALA trial

Gehrman

Angenete

Björholt

et al. 2016

Journal of British Surgery

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BackgroundOpen surgery with resection and colostomy (Hartmann's procedure) has been the standard treatment for perforated diverticulitis with purulent peritonitis. In recent years laparoscopic lavage has emerged as an alternative, with potential benefits for patients with purulent peritonitis, Hinchey grade III. The aim of this study was to compare laparoscopic lavage and Hartmann's procedure with health economic evaluation within the framework of the DILALA (DIverticulitis – LAparoscopic LAvage versus resection (Hartmann's procedure) for acute diverticulitis with peritonitis) trial.MethodsClinical effectiveness and resource use were derived from the DILALA trial and unit costs from Swedish sources. Costs were analysed from the perspective of the healthcare sector. The study period was divided into short‐term analysis (base‐case A), within 12 months, and long‐term analysis (base‐case B), from inclusion in the trial throughout the patient's expected life.ResultsThe study included 43 patients who underwent laparoscopic lavage and 40 who had Hartmann's procedure in Denmark and Sweden during 2010–2014. In base‐case A, the difference in mean cost per patient between laparoscopic lavage and Hartmann's procedure was €–8983 (95 per cent c.i. –16 232 to –1735). The mean(s.d.) costs per patient in base‐case B were €25 703(27 544) and €45 498(38 928) for laparoscopic lavage and Hartmann's procedure respectively, resulting in a difference of €–19 794 (95 per cent c.i. –34 657 to –4931). The results were robust as demonstrated in sensitivity analyses.ConclusionThe significant cost reduction in this study, together with results of safety and efficacy from RCTs, support the routine use of laparoscopic lavage as treatment for complicated diverticulitis with purulent peritonitis.

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“…Given that sample sizes were sufficient to summarize total visit cost for patients presenting with lead damage in the inpatient setting, we calculated the total hospitalization cost by summing the amount paid to the hospital by the insurer plus coinsurance, copayments, and deductibles paid by the patient. Given the distribution of total hospitalization costs observed, we excluded from cost analyses 19 patients whose total costs fell into the top 5% of the cohort (greater than $73 573 for the PM cohort, $191 042 for ICD, and $296 320 for the CRT‐D cohort) 9, 10, 11, 12. We hypothesized that these patients may have had other major procedures besides just lead revision or repair, resulting in the extreme variance in cost.…”

Section: Methodsmentioning

confidence: 99%

Incidence and Costs Related to Lead Damage Occurring Within the First Year After a Cardiac Implantable Electronic Device Replacement Procedure

Nichols

Vose

Mittal

2016

JAHA

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BackgroundInadvertent damage to leads for transvenous pacemakers, implantable cardioverter‐defibrillators, and cardiac resynchronization therapy defibrillators is an important complication associated with generator‐replacement procedures. We sought to estimate the incidence and costs associated with transvenous lead damage following cardiac implantable electronic device replacement.Methods and ResultsUsing the Truven Health Analytics MarketScan Commercial Research Database, we identified health care claims between 2009 and 2013 for lead damage following generator replacement. Patients were identified by claims with a procedure code for cardiac implantable electronic device replacement and then evaluated for 1 year. All follow‐up visits for lead damage were identified, and incidence, risk factors, and hospitalization costs were determined. A total of 22 557 patients with pacemakers, 20 632 with implantable cardioverter‐defibrillators, and 2063 with cardiac resynchronization therapy defibrillators met selection criteria. Incidence of lead damage was 0.46% for pacemaker replacement, 1.27% for implantable cardioverter‐defibrillator replacement, and 1.94% for cardiac resynchronization therapy defibrillator replacement procedures (P<0.001). After adjusting for patient characteristics, patients with implantable cardioverter‐defibrillators and cardiac resynchronization therapy defibrillators demonstrated risk of lead damage that was, respectively, double (hazard ratio 2.00, 95% CI 1.57–2.55) and >2.5 times (hazard ratio 2.58, 95% CI 1.73–3.83) that of patients with pacemakers. Lead revision or repair procedures were associated with increased inpatient hospitalization costs (mean $19 959 for pacemaker, $24 885 for implantable cardioverter‐defibrillator, and $46 229 for cardiac resynchronization therapy defibrillator; P=0.048, Kruskal–Wallis test).ConclusionsThese findings establish the first objective assessment of the incidence, risk factors, and economic burden of lead damage following cardiac implantable electronic device replacement in the United States. New care algorithms are warranted to avoid these events, which impose substantial burdens on patients, physicians, and payors.

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Effect of Laparoscopic Surgery on Health Care Utilization and Costs in Patients Who Undergo Colectomy

Abstract: Laparoscopic colectomy results in a significant reduction in health care costs and utilization in the short- and long-term postoperative periods.

Cited by 76 publications

References 12 publications

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

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

Health economic analysis of laparoscopic lavage versus Hartmann's procedure for diverticulitis in the randomized DILALA trial

Incidence and Costs Related to Lead Damage Occurring Within the First Year After a Cardiac Implantable Electronic Device Replacement Procedure

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