Multicenter Stratified Comparison of Hospital Costs Between Laparoscopic and Open Colorectal Cancer Resection: Influence of Tumor Location and Operative Risk

Abstract

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 s10474 to s20865 in the predefined subgroups. For colon cancer surgery (N.4202), laparoscopic resection was less expensive than open resection in all subgroups, savings because of laparoscopy ranged from s409 (<75 years ASA I-II) to s1932 (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 s501 (<75 years ASA I-II) to s2515 ( 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. Keywords: colorectal cancer, hospital costs, laparoscopy, population based registry, resection, tumor