title: A prospective case-matched comparison of clinical and financial outcomes of open versus laparoscopic colorectal resection.
abstract: BACKGROUND
  We aimed to assess the clinical outcomes and costs associated with laparoscopic resection within an elective colorectal practice.
  
  
  METHODS
  Over a 12-month period data were prospectively collected on patients undergoing elective colorectal resection under the care of a single consultant surgeon. Thirty patients undergoing laparoscopic colorectal resection were case-matched by type of resection, disease process, and, where appropriate, cancer stage to patients having open surgery. A cost analysis was carried out incorporating cost of surgical bed stay, theater time, and specific equipment costs.
  
  
  RESULTS
  In the 30 patients having laparoscopic resection, a conversion rate of 13% was observed. Surgery was performed for colorectal cancer in 83% of patients, and 53% of resections were rectal. No significant differences were found in age (65 versus 69 years, p = 0.415), BMI (27.4 versus 26.1, p = 0.527), POSSUM physiology score (16 versus 16.5, p = 0.102), American Society of Anesthesiologists (ASA) grade (2 versus 2, p = 0.171), or length of theater time (160 min versus 160 min, p = 0.233) between the laparoscopic and open patients. Hospital stay was reduced in the laparoscopic group (5 versus 9 days, p < 0.001). Average cost of surgical equipment used for a laparoscopic resection was greater than for open surgery (912.39 versus 276.41 pounds, p = 0.001). Cost of hospital stay was significantly less (1259.75 versus 2267.55 pounds, p < 0.001). Cost of operating room time was similar for the two groups (2066.63 versus 1945.07 pounds, p = 0.152). Overall no significant cost difference could be found between open and laparoscopic resection (4560.9 versus 4348.45 pounds, p = 0.976). More postoperative complications were seen in the open resection group (14 versus 4, p < 0.001).
  
  
  CONCLUSIONS
  Intraoperative equipment costs are greater for laparoscopic resection than for open surgery. However, benefits can be seen in terms of quicker recovery and shorter hospital stay. Laparoscopic surgery is a financially viable alternative to open resection in selected patients.
authors.affiliation: Department of Surgery, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, United Kingdom.
authors.forename: S E
authors.initials: SE
authors.lastname: Noblett
authors.forename: A F
authors.initials: AF
authors.lastname: Horgan
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003082:Colectomy / Q000191:economics* / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome; D006113:United Kingdom