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A cost comparison of laparoscopic and open colon surgery in a publicly funded academic institution

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Abstract

Background

The objective of this study was to compare the total hospital cost of laparoscopic (lap) and open colon surgery at a publicly funded academic institution.

Methods

Patients undergoing elective laparoscopic or open colon surgery for all indications at the University Health Network, Toronto, Canada, from April 2004 to March 2009 were included. Patient demographic, operative, and outcome data were reviewed retrospectively. Hospital costs were determined from the Ontario Case Costing Initiative, adjusted for inflation, and compared using the Mann–Whitney U test. Linear regression was used to analyze the relationship between length of stay and total hospital cost.

Results

There were 391 elective colon resections (223 lap/168 open, 15.4 % conversion). There was no difference in median age, gender, or Charlson score. Body mass index was slightly higher for laparoscopic surgery (27.5/25.9 lap/open; p = 0.008), while the American Society of Anesthesiologists score was slightly higher for open surgery. Median operative time was greater for laparoscopic surgery (224/196 min, lap/open; p = 0.001). There was no difference in complication rates (21.6/22.5 % lap/open; p = 0.900), reoperations (5.8/6.5 % lap/open; p = 0.833) or 30-day readmissions (7.6/12.5 % lap/open; p = 0.122). Number of emergency room visits was greater with open surgery (12.6/20.8 % lap/open; p = 0.037). Operative cost was higher for laparoscopic surgery ($4,171.37/3,489.29 lap/open; p = 0.001), while total hospital cost was significantly reduced ($9,600.22/12,721.41 lap/open; p = 0.001). Median length of stay was shorter for laparoscopic surgery (5/7 days lap/open; p = 0.000), and this correlated directly with hospital cost.

Conclusions

Laparoscopic colon surgery is associated with increased operative costs but significantly lower total hospital costs. The cost savings is related, in part, to reduced length of stay with laparoscopic surgery.

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Disclosures

Dr. Allan Okrainec received an honorarium from Covidien as a consultant. Dr. Ashley Vergis received an honorarium from Baxter as an advisory board member. Drs Krista Hardy, Timothy Jackson, and David Urbach, and Ms. Josephine Kwong and Ms. Kristen Pitzul, have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, University of Manitoba, Winnipeg, MB, Canada

    Krista M. Hardy & Ashley S. Vergis

  2. Division of General Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street, 325 8-MP, Toronto, ON, M5T 2S8, Canada

    Krista M. Hardy, Josephine Kwong, Kristen B. Pitzul, Timothy D. Jackson, David R. Urbach & Allan Okrainec

  3. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Krista M. Hardy, Timothy D. Jackson, David R. Urbach & Allan Okrainec

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  1. Krista M. Hardy
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Correspondence to Krista M. Hardy.

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Hardy, K.M., Kwong, J., Pitzul, K.B. et al. A cost comparison of laparoscopic and open colon surgery in a publicly funded academic institution. Surg Endosc 28, 1213–1222 (2014). https://doi.org/10.1007/s00464-013-3311-y

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  • DOI: https://doi.org/10.1007/s00464-013-3311-y

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