TY - JOUR
T1 - Multicenter Stratified Comparison of Hospital Costs between Laparoscopic and Open Colorectal Cancer Resections
AU - Govaert, Johannes A.
AU - Fiocco, Marta
AU - Van Dijk, Wouter A.
AU - Kolfschoten, Nikki E.
AU - Prins, Hubert A.
AU - Dekker, Jan Willem T.
AU - Tollenaar, Rob A.E.M.
AU - Tanis, Pieter J.
AU - Wouters, Michel W.J.M.
N1 - Publisher Copyright:
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Objective: To compare actual 90-day hospital costs between elective open and laparoscopic colon and rectal cancer resection in a daily practice multicenter setting stratified for operative risk. Background: Laparoscopic resection has developed as a commonly accepted surgical procedure for colorectal cancer. There are conflicting data on the influence of laparoscopy on hospital costs, without separate analyses based on operative risk. Methods: Retrospective analyses using a population-based database (Dutch Surgical Colorectal Audit). All elective resections for a T1-3N0-2M0 stage colorectal cancer were included between 2010 and 2012 in 29 Dutch hospitals. Operative risk was stratified for age (<75 years or ≥75 years) and ASA status (I-II/III-IV). Ninety-day hospital costs were measured uniformly in all hospitals based on time-driven activity-based costing. Results: Total 90-day hospital costs ranged from €10474 to €20865 in the predefined subgroups. For colon cancer surgery (N = 4202), laparoscopic resection was significant less expensive than open resection in all subgroups, savings because of laparoscopy ranged from €409 (<75 years ASA I-II) to €1932 (≥75 years ASA I-II). In patients ≥75 years and ASA I-II, laparoscopic resection was associated with 46% less mortality (P = 0.05), 41% less severe complications (P < 0.001), 25% less hospital stay (P = 0.013), and 65% less ICU stay (P < 0.001). For rectal cancer surgery (N=2328), all laparoscopic subgroups had significantly higher total hospital costs, ranging from €501 (<75 years ASA I-II) to €2515 (≥75 years ASA III-IV). Conclusions: Laparoscopic resection resulted in the largest cost reduction in patients over 75 years with ASA I-II undergoing colonic resection, and the largest cost increase in patients over 75 years with ASA III-IV undergoing rectal resection as compared with an open approach.
AB - Objective: To compare actual 90-day hospital costs between elective open and laparoscopic colon and rectal cancer resection in a daily practice multicenter setting stratified for operative risk. Background: Laparoscopic resection has developed as a commonly accepted surgical procedure for colorectal cancer. There are conflicting data on the influence of laparoscopy on hospital costs, without separate analyses based on operative risk. Methods: Retrospective analyses using a population-based database (Dutch Surgical Colorectal Audit). All elective resections for a T1-3N0-2M0 stage colorectal cancer were included between 2010 and 2012 in 29 Dutch hospitals. Operative risk was stratified for age (<75 years or ≥75 years) and ASA status (I-II/III-IV). Ninety-day hospital costs were measured uniformly in all hospitals based on time-driven activity-based costing. Results: Total 90-day hospital costs ranged from €10474 to €20865 in the predefined subgroups. For colon cancer surgery (N = 4202), laparoscopic resection was significant less expensive than open resection in all subgroups, savings because of laparoscopy ranged from €409 (<75 years ASA I-II) to €1932 (≥75 years ASA I-II). In patients ≥75 years and ASA I-II, laparoscopic resection was associated with 46% less mortality (P = 0.05), 41% less severe complications (P < 0.001), 25% less hospital stay (P = 0.013), and 65% less ICU stay (P < 0.001). For rectal cancer surgery (N=2328), all laparoscopic subgroups had significantly higher total hospital costs, ranging from €501 (<75 years ASA I-II) to €2515 (≥75 years ASA III-IV). Conclusions: Laparoscopic resection resulted in the largest cost reduction in patients over 75 years with ASA I-II undergoing colonic resection, and the largest cost increase in patients over 75 years with ASA III-IV undergoing rectal resection as compared with an open approach.
KW - colorectal cancer
KW - hospital costs
KW - laparoscopy
KW - population based registry
KW - resection
KW - tumor
UR - http://www.scopus.com/inward/record.url?scp=84986209216&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000002000
DO - 10.1097/SLA.0000000000002000
M3 - Article
C2 - 27611610
AN - SCOPUS:84986209216
SN - 0003-4932
VL - 266
SP - 1021
EP - 1028
JO - Annals of Surgery
JF - Annals of Surgery
IS - 6
ER -