Single center cost analysis of single-port and conventional laparoscopic surgical treatment in colorectal malignant diseases
- 238 Downloads
Background and purpose
Single-port laparoscopy (SPL) is a relatively new technique, used in various procedures. There is limited knowledge about the cost effectiveness and the learning curve of this technique. The primary aim of this study was to compare hospital costs between SPL and conventional laparoscopic resections (CLR) for colorectal cancer; the secondary aim was to identify a learning curve of SPL.
All elective colorectal cancer SPL and CLR performed in a major teaching hospital between 2011 and 2012 that were registered in the Dutch Surgical Colorectal Audit were included (n = 267). The economic evaluation was conducted from a hospital perspective, and costs were calculated using time-driven activity-based costing methodology up to 90 days after discharge. When looking at SPL only, the introduction year (2011) was compared to the next year (2012).
SPL (n = 78) was associated with lower mortality, lower reintervention rates, and more complications as compared to CLR (n = 189); however, none of these differences were statistically significant. A significant shorter operating time was seen in the SPL. Total costs were higher for SPL group as compared to CLR; however, this difference was not statistically significant. For the SPL group, most clinical outcomes improved between 2011 and 2012; moreover, total hospital costs for SPL in 2012 became comparable to CLR.
No significant differences in financial outcomes between SPL and CLR were identified. After the introduction period, SPL showed similar results as compared to CLR. Conclusions are based on a small single-port group and the conclusions of this manuscript should be an impetus for further research.
KeywordsSingle-port laparoscopy Colorectal cancer surgery Cost analysis Laparoscopic surgery
All authors participated sufficiently to the content of this manuscript. No acknowledgements.
Compliance with ethical standards
Yoen van der Linden, Johannes Govaert, Marta Fiocco, Wouter van Dijk, Daniel Lips, and Hubert Prins have no conflicts of interest or financial ties to disclose.
Conflicts of interest
The authors declare that they have no conflicts of interest.
- 2.Feliciotti F, Guerrieri M, Paganini AM, De Sanctis A, Campagnacci R, Perretta S, D’Ambrosio G, Lezoche E (2003) Long-term results of laparoscopic versus open resections for rectal cancer for 124 unselected patients. Surg Endosc 17(10):1530–1535. doi: 10.1007/s00464-002-8874-y CrossRefPubMedGoogle Scholar
- 6.Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MH, de Lange- Klerk ES, Lacy AM, Bemelman WA, Andersson J, Angenete E, Rosenberg J, Fuerst A, Haglind E, Group, CIS (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372(14):1324–1332. doi: 10.1056/NEJMoa1414882 CrossRefPubMedGoogle Scholar
- 11.Antoniou SA, Koch OO, Antoniou GA, Lasithiotakis K, Chalkiadakis GE, Pointner R, Granderath FA (2014) Meta-analysis of randomized trials on single-incision laparoscopic versus conventional laparoscopic appendectomy. Am J Surg 207(4):613–622. doi: 10.1016/j.amjsurg.2013.07.045 CrossRefPubMedGoogle Scholar
- 15.van der Linden YT, Boersma D, van Poll D, Lips DJ, Prins HA (2015) Single-port laparoscopic appendectomy in children: single center experience in 50 patients. Acta Chir Belg 115 (2):118–122Google Scholar
- 17.Van Leersum NJ, Snijders HS, Henneman D, Kolfschoten NE, Gooiker GA, ten Berge MG, Eddes EH, Wouters MW, Tollenaar RA, Dutch Surgical Colorectal Cancer Audit G, Bemelman WA, van Dam RM, Elferink MA, Karsten TM, van Krieken JH, Lemmens VE, Rutten HJ, Manusama ER, van de Velde CJ, Meijerink WJ, Wiggers T, van der Harst E, Dekker JW, Boerma D (2013) The Dutch surgical colorectal audit. Eur J Surg Oncol: J Eur Soc Surg Oncol Br Assoc Surg Oncol 39(10):1063–1070. doi: 10.1016/j.ejso.2013.05.008 CrossRefGoogle Scholar
- 18.Kolfschoten NE, van Leersum NJ, Gooiker GA, Marang van de Mheen PJ, Eddes EH, Kievit J, Brand R, Tanis PJ, Bemelman WA, Tollenaar RA, Meijerink J, Wouters MW (2013) Successful and safe introduction of laparoscopic colorectal cancer surgery in Dutch hospitals. Ann Surg 257(5):916–921. doi: 10.1097/SLA.0b013e31825d0f37 CrossRefPubMedGoogle Scholar
- 19.Performation. wwwperformationcomGoogle Scholar
- 20.Klarenbeek BR, Coupe VM, van der Peet DL, Cuesta MA (2011) The cost effectiveness of elective laparoscopic sigmoid resection for symptomatic diverticular disease: financial outcome of the randomized control Sigma trial. Surg Endosc 25(3):776–783. doi: 10.1007/s00464-010-1252-2 CrossRefPubMedGoogle Scholar
- 21.Kaplan RS, Anderson SR (2004) Time-driven activity-based costing. Harv Bus Rev 82(11):131-138–131-150Google Scholar
- 22.Porter ME, Lee TH (2013) The strategy that will fix health care. Harv Bus Rev 91(12):24–24Google Scholar
- 23.McCulloch CE, Searle SR (2001) Generalized, linear, and mixed models, 1st edn. Wiley, New YorkGoogle Scholar
- 27.Huscher CG, Mingoli A, Sgarzini G, Mereu A, Binda B, Brachini G, Trombetta S (2012) Standard laparoscopic versus single-incision laparoscopic colectomy for cancer: early results of a randomized prospective study. Am J Surg 204(1):115–120. doi: 10.1016/j.amjsurg.2011.09.005 CrossRefPubMedGoogle Scholar