Comparison of outcomes and costs between laparoscopic distal pancreatectomy and open resection at a single center
- 444 Downloads
The cost implications of laparoscopic distal pancreatectomy (LDP) and a detailed breakdown of hospital expenditures has not been presented in the literature to date. This study aimed to compare hospital costs and short-term clinical outcomes between LDP and open distal pancreatectomy (ODP).
The authors evaluated all the distal pancreatic resections performed at their center between January 2004 and March 2010. Parametric and nonparametric statistical analysis was used to compare hospital departmental and total hospital costs as well as oncologic and surgical outcomes.
A total of 118 cases (42 laparoscopic resections, including 5 conversions, and 76 open resections) were analyzed. The demographic characteristics were similar between the groups except for a predominance of females in the laparoscopic group (P = 0.036). The indications for surgery differed by a paucity of malignant tumors being approached laparoscopically (P < 0.001). Intraoperatively, there were no differences in estimated blood loss, operating room time, or transfusion requirement. The pathologic outcomes did not differ significantly. The median hospital length of stay (LOS) was 5 days (range 3–31 days) for the LDP cohort and 7 days (range 4–19 days) for the ODP cohort (P < 0.001). Postoperative pancreatic fistula occurred for 22 patients, with a higher proportion observed in the LDP group (28.57%; n = 12) than in the open group (13.16%; n = 10; P = 0.05). However, the rates for grade B and higher grade fistula were higher in the ODP group (0 LDP and 4 ODP). The median preadmission and operative costs did not differ significantly. The ODP cohort had significantly higher costs in all other hospital departments, including the total cost.
LDP is both a cost-effective and safe approach for distal pancreatic lesions. This series showed a shorter LOS and lower total hospital costs for LDP than for ODP, accompanied by equivalent postoperative outcomes.
KeywordsCosts and cost analysis Laparoscopy Pancreas Pancreatectomy/economics Pancreatectomy/methods Pancreatic neoplasms
The authors thank Mila Geslani and Jane Chen from the UHN Case Costing Center for acquisition of costing data.
Adrian Fox receives scholarship funding from Sanofi-Aventis while in the training position of Surgical Clinical Fellow at University Health Network. Kristen Pitzul, Faizal Bhojani, Max Kaplan, Carol-Anne Moulton, Alice C. Wei, Ian McGilvray, Sean Cleary, and Allan Okrainec have no conflicts of interest or financial ties to disclose.
- 2.Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW, Sellers JB, Merchant NB, Scoggins CR, Martin RC III, Kim HJ, Ahmad S, Cho CS, Parikh AA, Chu CK, Hamilton NA, Doyle CJ, Pinchot S, Hayman A, McClaine R, Nakeeb A, Staley CA, McMasters KM, Lillemoe KD (2010) A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg 210(779–785):86–87Google Scholar
- 4.Committee on Quality of Health Care in America (2001) Crossing the quality chasm: a new health system for the 21st century Institute of Medicine. Retrieved 23 January 2011 at http://www.nap.edu/openbook.php?record_id=10027&page=39#p200048209970039001
- 8.Practice HCo (2007) HPB community of practice workshop. Retrieved 9 Feb 2011 at http://www.cancercare.on.ca/SurgicalOncologyNews/642_651.htm
- 12.Health OMo (2011) Ontario health insurance (OHIP) Schedule of benefits and fees. Retrieved 22 Jan 2011 at http://www.health.gov.on.ca/english/providers/program/ohip/sob/sob_mn.html
- 16.Cho CS, Kooby DA, Schmidt CM, Nakeeb A, Bentrem DJ, Merchant NB, Parikh AA, Martin RC II, Scoggins CR, Ahmad SA, Kim HJ, Hamilton N, Hawkins WG, Weber SM (2011) Laparoscopic versus open left pancreatectomy: can preoperative factors indicate the safer technique? Ann Surg 253(5):975–980. Erratum in: Ann Surg 254(2):391Google Scholar
- 21.Schmidt CM (2011) Randomized trial of laparoscopic versus open distal pancreatectomy in patients with pancreatic disease. Retrieved 23 Jan 2011 at http://clinicaltrials.gov/ct2/show/NCT00988793