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Outcomes superior with laparoscopic vs. open colorectal surgery
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Laparoscopic surgery was found to be more cost-effective and to produce better patient outcomes, compared to open surgery, for patients who underwent elective colorectal resections.
“The clinical benefits of laparoscopy have been well established in colorectal surgery, however there is still significant room to increase utilization. With the pressure on providers to optimize patient outcomes and costs, we undertook this study to assess the current state of laparoscopy compared to open colorectal surgery in the U.S.,” Deborah S. Keller, MD, of Colorectal Surgical Associates, Houston, Texas, told Healio Gastroenterology.
Deborah S. Keller
Keller and colleagues enrolled 6,343 patients undergoing elective colorectal resections between January 1, 2013 and December 31, 2013 using the Premier Perspective database. The patients were assigned to either the laparoscopic or open surgery groups and were controlled for demographics, diagnosis, procedural and hospital characteristics, surgeon volume and surgeon specialty.
Length of stay, complications, readmission rates and cost by surgical approach were the main outcomes measured.
Patients in the laparoscopic cohort had significantly shorter lengths of stay, fewer readmissions and complications, and lower mortality rates (P < .0001 for all four), compared to patients who underwent open surgery. The mean length of stay was 5.78 days in the laparoscopic group compared to 7.8 days in the open surgery group, the readmission rate was 5.82% compared to 7.68%, the complication rate was 32.6% compared to 42.28%, and the mortality rate was 0.52% compared to 1.28%. Overall, total costs were also significantly lower in the laparoscopic group compared to the open surgery group (mean $17,269 compared to $20,552, P < .0001).
“We used the Premier Perspectives national inpatient database for 2013 and compared propensity matched groups of laparoscopic and open cohorts for clinical and financial outcomes. We found in current, matched patients, laparoscopy resulted in shorter lengths of stay, lower readmission rates, lower complications, lower mortality, and lower overall costs, as well as lower costs in almost every individual cost category. Thus, laparoscopy is now more cost-effective and produces better patient outcomes than open colorectal surgery. With these findings, we can confidentially say that minimally invasive colorectal surgery is now the standard that should be offered to patients, providing value to both patient and providers,” Keller said. – by Suzanne Reist
Disclosures: Delaney reports he is a consultant for Covidien (Mansfield, MA, USA) educational courses. Please see the full study for a list of all other authors’ relevant financial disclosures.
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