Has laparoscopic colorectal surgery become more cost-effective over time?

Aly, Omar; Quayyum, Zahidul

doi:10.1007/s00384-012-1410-1

Cited by 17 publications

(6 citation statements)

References 29 publications

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“…This study did not include imaging costs, prescribed medication costs, outpatient costs, or community costs. Despite not having included these, similar values to previous studies were observed [10-12, 14-17]. Early laparoscopy cost-effectiveness studies, reported varying results comparing the cost of laparoscopic to open colorectal surgery [15, 17].…”

Section: Discussion/conclusionsupporting

confidence: 76%

“…Higher operating room costs were due to more expensive equipment and longer operation duration due to the learning curve of the new laparoscopic approach [16]. In more recent studies, cost-benefits for laparoscopic surgery were realized with shorter LOS and better postoperative outcomes [10-12, 14]. Keller et al [12] reported a reduction of 22% in hospital costs in favor of laparoscopic surgery (OR 0.78, C.I.…”

Section: Discussion/conclusionmentioning

confidence: 99%

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The Introduction of Laparoscopic Colorectal Surgery: Can It Improve Hospital Economics?

et al. 2020

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Introduction: Clinical benefits of laparoscopic surgery are well established, but evidence for financial benefits is limited. This study aimed to compare the financial impact of the introduction of laparoscopic colorectal surgery. Methods: This study included patients who underwent colorectal surgery between January 2010 and 2015. We collected a range of financial data and divided the patients into 2 groups. Primary outcome was total cost defined by surgical-related costs. Results: A total of 1,246 patients were included, of which 440 surgeries were performed laparoscopically. The total median cost of laparoscopy was higher compared to open surgery (EUR 4,665 vs. EUR 4,268, p = 0.001). Laparoscopy was associated with higher equipment costs (EUR 857 vs. EUR 232, p < 0.001), longer operating time (3.2 vs. 2.5 hours, p < 0.001), and more readmissions (10.9 vs. 8.5%, p < 0.001). However, after adjusting for heterogeneity, no difference was found in total cost. Surgical-related costs were counterbalanced by lower costs associated with shorter median hospital stay (6 vs. 9 days, p < 0.001), less morbidity (37.3 vs. 55.1%, p < 0.001), and less mortality (1.8 vs. 5.6%, p = 0.013) for laparoscopy. Conclusion: During the introduction of laparoscopy for colorectal surgery, no significant differences were found in total cost between laparoscopic and open colorectal surgery. However, favorable postoperative outcomes were achieved with laparoscopic surgery.

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Section: Discussion/conclusionsupporting

confidence: 76%

Section: Discussion/conclusionmentioning

confidence: 99%

The Introduction of Laparoscopic Colorectal Surgery: Can It Improve Hospital Economics?

et al. 2020

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“…It must also be considered that the robotic surgery market has been driven by one main provider during the last two decades, and that the arrival of competitors should allow for costs to be diminished and favour the evolution of platforms towards incremental versatility. In an analogous scenario, and non-surprisingly in hindsight, Aly et al [ 8 ] showed that laparoscopic colorectal surgery is becoming more cost-effective over time. In this systematic review, the authors showed that the cost-difference percentage between both approaches is decreasing over time (R-value = − 0.44; P = 0.046), projecting that the results of future economic evaluations would unequivocally show that laparoscopic surgery is cheaper than open surgery.…”

Section: Discussionmentioning

confidence: 99%

Robotic versus laparoscopic proctectomy: a comparative study of short-term economic and clinical outcomes

Larach

Flynn

Tew

et al. 2023

Int J Colorectal Dis

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Background Although several studies compare the clinical outcomes and costs of laparoscopic and robotic proctectomy, most of them reflect the outcomes of the utilisation of older generation robotic platforms. The aim of this study is to compare the financial and clinical outcomes of robotic and laparoscopic proctectomy within a public healthcare system, utilising a multi-quadrant platform. Methods Consecutive patients undergoing laparoscopic and robotic proctectomy between January 2017 and June 2020 in a public quaternary centre were included. Demographic characteristics, baseline clinical, tumour and operative variables, perioperative, histopathological outcomes and costs were compared between the laparoscopic and robotic groups. Simple linear regression and generalised linear model analyses with gamma distribution and log-link function were used to determine the impact of the surgical approach on overall costs. Results During the study period, 113 patients underwent minimally invasive proctectomy. Of these, 81 (71.7%) underwent a robotic proctectomy. A robotic approach was associated with a lower conversion rate (2.5% versus 21.8%;P = 0.002) at the expense of longer operating times (284 ± 83.4 versus 243 ± 89.8 min;P = 0.025). Regarding financial outcomes, robotic surgery was associated with increased theatre costs (A$23,019 ± 8235 versus A$15,525 ± 6382; P < 0.001) and overall costs (A$34,350 ± 14,770 versus A$26,083 ± 12,647; P = 0.003). Hospitalisation costs were similar between both approaches. An ASA ≥ 3, non-metastatic disease, low rectal cancer, neoadjuvant therapy, non-restorative resection, extended resection, and a robotic approach were identified as drivers of overall costs in the univariate analysis. However, after performing a multivariate analysis, a robotic approach was not identified as an independent driver of overall costs during the inpatient episode (P = 0.1). Conclusion Robotic proctectomy was associated with increased theatre costs but not with increased overall inpatient costs within a public healthcare setting. Conversion was less common for robotic proctectomy at the expense of increased operating time. Larger studies will be needed to confirm these findings and examine the cost-effectiveness of robotic proctectomy to further justify its penetration in the public healthcare system.

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“…We found a significant difference in the index hospitalization costs between laparoscopic and open cases ($24 196 vs $31 601), which is in agreement with the trend seen in a recent systemic review. 9 In addition, in both the initial 3 months and the first year after surgery, patients who underwent laparoscopic procedures were significantly more likely to require fewer days of health care utilization and spend less on their overall health care and drug expenses. These results likely reflect the well-documented benefits of laparoscopy, which include faster recovery, less pain, and fewer complications.…”

Section: Discussionmentioning

confidence: 99%

“…2 This increase in up-front costs, however, is offset by decreases in length of stay, complications, readmissions, and mortality, each of which can carry significant financial consequences. 8 In addition, a recent systemic review 9 showed that, as experience with laparoscopy has increased, there has been a trend toward overall improved cost-effectiveness compared with open surgery. While these short-term outcomes are significant, there has been little research into the long-term effects of laparoscopy on health care resource utilization beyond the immediate postoperative period.…”

mentioning

confidence: 99%

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

et al. 2015

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Has laparoscopic colorectal surgery become more cost-effective over time?

Cited by 17 publications

References 29 publications

The Introduction of Laparoscopic Colorectal Surgery: Can It Improve Hospital Economics?

The Introduction of Laparoscopic Colorectal Surgery: Can It Improve Hospital Economics?

Robotic versus laparoscopic proctectomy: a comparative study of short-term economic and clinical outcomes

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

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