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Minimally invasive versus open surgery in the Medicare population: a comparison of post-operative and economic outcomes

Abstract

Background

Despite strong evidence demonstrating the clinical and economic benefits of minimally invasive surgery (MIS), utilization of MIS in the Medicare population is highly variable and tends to be lower than in the general population. We sought to compare the post-operative and economic outcomes of MIS versus open surgery for seven common surgical procedures in the Medicare population.

Methods

Using the 2014 Medicare Provider Analysis and Review Inpatient Limited Data Set, patients undergoing bariatric, cholecystectomy, colectomy, hysterectomy, inguinal hernia, thoracic, and ventral hernia procedures were identified using DRG and ICD-9 codes. Adjusting for patient demographics and comorbidities, the odds of complication and all-cause 30-day re-admission were compared among patients undergoing MIS versus open surgery stratified by operation type. A generalized linear model was used to calculate the estimated difference in length of stay (LOS), Medicare claim cost, and Medicare reimbursement.

Results

Among 233,984 patients, 102,729 patients underwent an open procedure versus 131,255 who underwent an MIS procedure. The incidence of complication after MIS was lower for 5 out of the 7 procedures examined (OR 0.36–0.69). Re-admission was lower for MIS for 6 out of 7 procedures (OR 0.43–0.87). MIS was associated with shorter LOS for 6 procedures (point estimate range 0.35–2.47 days shorter). Medicare claim costs for MIS were lower for 4 (range $3010.23–$4832.74 less per procedure) and Medicare reimbursements were lower for 3 (range $841.10–$939.69 less per procedure).

Conclusions

MIS benefited Medicare patients undergoing a range of surgical procedures. MIS was associated with fewer complications and re-admissions as well as shorter LOS and lower Medicare costs and reimbursements versus open surgery. MIS may represent a better quality and cost proposition in the Medicare population.

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Acknowledgements

The authors acknowledge Mr. and Mrs. John Rodda and The Rodda Family Partnership, LTD, for their generous support of this research study at Johns Hopkins.

Funding

The authors acknowledge the funding support provided by Mr. and Mrs. John Rodda and The Rodda Family Partnership, LTD.

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Correspondence to Caleb J. Fan.

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Disclosures

Mr. Hung-Lun Chien is an employee of Medtronic, Inc. Drs. Caleb J. Fan, Matthew J. Weiss, Jin He, Christopher L. Wolfgang, John L. Cameron, Timothy M. Pawlik, and Martin A. Makary have no conflicts of interest or financial ties to disclose.

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Fan, C.J., Chien, HL., Weiss, M.J. et al. Minimally invasive versus open surgery in the Medicare population: a comparison of post-operative and economic outcomes. Surg Endosc 32, 3874–3880 (2018). https://doi.org/10.1007/s00464-018-6126-z

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  • DOI: https://doi.org/10.1007/s00464-018-6126-z

Keywords

  • MIS
  • Medicare
  • Bariatric
  • Cholecystectomy
  • Colectomy
  • Hernia