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

Govaert, J.A.; Fiocco, M.; Dijk, W.A. van; Kolfschoten, N.E.; Prins, H.A.; Dekker, J.W.T.; ... ; Dutch Value Based Hlthcare (2016)

Article / Letter to editor

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

• All authors: Govaert, J.A.; Fiocco, M.; Dijk, W.A. van; Kolfschoten, N.E.; Prins, H.A.; Dekker, J.W.T.; Tollenaar, R.A.E.M.; Tanis, P.J.; Wouters, M.W.J.M.; Dutch Value Based Hlthcare
• Date: 2016
• Journal: Annals of Surgery
• DOI: doi:10.1097/SLA.0000000000002000