Laparoscopic colectomy is cheaper than conventional open resection.
OBJECTIVE
International randomized trials have endorsed the routine use of laparoscopic techniques in colorectal surgery. The authors hypothesize that the overall care pathway in minimal access resection was cheaper than conventional open resection.


METHODS
This was a case-matched study of consecutive patients undergoing laparoscopic resection between July 2005 and February 2006. Intraoperative (costs, duration, incision length) and postoperative [morbidity, length of stay (LOS), readmission] parameters were examined. Institutional retrospective open controls and national validated figures were used for costings.


RESULTS
Thirty-five laparoscopic and 53 open resections were evaluated. Median LOS was 5 days in the laparoscopic group vs 12 in the open group (P = 0.001). There were two conversions (5.7%) and two readmissions. Mean operative cost of laparoscopic resection was 1557.08 euros, therefore 2.4 bed days need to be saved to recoup the increased cost compared with open resection. The actual median save is 7 days (P = 0.031). A mean of 4591.38 euros and 7 bed days per case is saved by performing the resection laparoscopically. Subgroup analysis of laparoscopic resections clearly demonstrates similar trends.


CONCLUSIONS
The institutional saving is over 150,000 euros and 245 bed days during the study period. Despite higher operative spending, laparoscopic colorectal resections are significantly cheaper than conventional open resections.
Ridgway
P F
PF
Department of Surgery, Adelaide and Meath Hospital incorporating the National Children's Hospital (AMNCH), Dublin, Ireland. p.ridgway@ic.ac.uk
Boyle
E
E
Keane
F B
FB
Neary
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003082:Colectomy / Q000191:economics* / Q000706:statistics & numerical data; D003107:Colorectal Surgery / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007431:Intraoperative Complications / Q000191:economics; D010535:Laparoscopy / Q000191:economics* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics