Cost-effectiveness of laparoscopy in children.
BACKGROUND
Laparoscopy may offer fast recovery and improved cosmesis, but its cost has been perceived as excessive.


OBJECTIVE
To analyze the total hospital costs of laparoscopy vs open surgery.


METHODS
Retrospective cost-effectiveness analysis evaluating all cases performed in a 36-month period (September 1995 to August 1998). Cases were evaluated for operative time, itemized cost of supplies, and length of hospitalization.


METHODS
Operations performed by pediatric surgeons in a tertiary care children's hospital.


METHODS
Consecutive children undergoing laparoscopic or open appendectomies, cholecystectomies, fundoplications, and splenectomies. Patients were not randomized to laparoscopy, or open surgery.


METHODS
Laparoscopic procedures performed with a core set of reusable equipment and a limited number of disposable instruments.


METHODS
Cost surplus of laparoscopy was evaluated, and compared with savings associated with decreased hospital stay, to obtain cost-effectiveness of laparoscopy per procedure.


RESULTS
There were 26 laparoscopic and 359 open appendectomies; 33 laparoscopic and 3 open cholecystectomies; 16 laparoscopic and 18 open fundoplications; and 16 laparoscopic and 7 open splenectomies. Excess operating costs per procedure were $442.00 for appendectomy, $634.60 for fundoplication, $847.50 for cholecystectomy, and $1551.30 for splenectomy. Hospital stay was decreased for all laparoscopies, resulting in an overall savings per laparoscopic procedure of $2369.90 for appendectomy, $5390.90 for fundoplication, $1161.00 for cholecystectomy, and $858.90 for splenectomy.


CONCLUSIONS
Laparoscopy is cost-effective, particularly for fundoplication, appendectomy, and cholecystectomy. Detailing the costs of supplies, operating time, and length of stay allows interinstitutional comparison and critical cost-analysis of laparoscopy. With a more selective use of reusable instruments and further shortening of operative time, the global savings of laparoscopy may increase.
Luks
F I
FI
Division of Pediatric Surgery, Brown University School of Medicine, Providence, RI 02905, USA. Francois_Luks@brown.edu
Logan
J
J
Breuer
C K
CK
Kurkchubasche
A G
AG
Wesselhoeft
C W
CW
Tracy
T F
TF
D000293:Adolescent; D001062:Appendectomy / Q000191:economics / Q000379:methods; D002648:Child; D002675:Child, Preschool; D017081:Cholecystectomy, Laparoscopic / Q000191:economics; D003362:Cost-Benefit Analysis; D013505:Digestive System Surgical Procedures / Q000191:economics / Q000379:methods*; D018662:Fundoplication / Q000191:economics / Q000379:methods; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000191:economics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020706:Laparoscopes; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay; D012189:Retrospective Studies; D012237:Rhode Island; D013156:Splenectomy / Q000191:economics / Q000379:methods; D018709:Statistics, Nonparametric