Systematic review of the costs of laparoscopic colorectal surgery.
OBJECTIVE
Recent studies have confirmed the clinical efficacy of laparoscopic colorectal surgery; however, its use has not become widespread. One reason for this is perceived economic implications. A systematic review was undertaken examining the costs of laparoscopic colorectal surgery.


METHODS
Electronic databases were searched for articles comparing laparoscopic colorectal surgery and open surgery. Primary outcome measures were operating room, direct hospital, and indirect costs. Secondary outcomes were conversion rates and length of hospital stay. The percentage difference in costs was used for comparisons between studies.


RESULTS
Twenty-nine articles were identified in which cost data were presented (total number of patients 3,681); the economic data in most studies was limited. Operating room costs were greater for laparoscopic colorectal surgery than open surgery in all studies (median difference, 50 percent; interquartile range, 27-78 percent; P < 0.001). There was no overall difference in total hospital costs (median difference, 0 percent; interquartile range, -17.5 to 21 percent). Only two articles collected data on indirect costs, with both in favor of laparoscopic colorectal surgery. Hospital stay was shorter for laparoscopic colorectal surgery in all studies (median difference, 2.8 days; interquartile range, 1.3-3.7; P < 0.001). Median conversion rate was 7.8 percent (mean, 14 percent; interquartile range, 6-21 percent).


CONCLUSIONS
Operating room costs are greater for laparoscopic colorectal surgery than open surgery. Total hospital costs are similar. There may be societal benefits associated with lower indirect costs for laparoscopic colorectal surgery. Cost should not be a deterrent to performing laparoscopic colorectal surgery.
Dowson
Henry M
HM
Minimal Access Therapy Training Unit, Royal Surrey County Hospital, Guildford, Surrey, UK. hdowson@doctors.org.uk
Huang
Andy
A
Soon
Yuen
Y
Gage
Heather
H
Lovell
David P
DP
Rockall
Timothy A
TA
D003106:Colon / Q000601:surgery*; D003108:Colonic Diseases / Q000601:surgery; D017598:Efficiency, Organizational; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D009873:Operating Rooms / Q000191:economics; D012002:Rectal Diseases / Q000601:surgery; D012007:Rectum / Q000601:surgery*