Economics and the laparoscopic surgery learning curve: comparison with open surgery for rectosigmoid cancer.
BACKGROUND
Wide-ranging costs of laparoscopic surgery (LAP) are associated with variations in the experience levels of surgeons. There is no available report on the changes of economic outcomes relative to the LAP learning curve in the treatment of colorectal cancer. In the present study, we have compared changes in economic outcomes according to the LAP learning curve with the economic outcomes of open surgery (OS) for rectosigmoid cancer.


METHODS
A total of 197 patients with rectosigmoid cancer were included in this analysis; 116 received LAP and 81 received OS. Scatter of operative times demonstrated an early learning period of 37 cases in LAP. The following outcomes were compared between LAP and OS during the early learning period and experienced periods; operating room (OR) costs, OR-related hospital profit, total hospital charge, and patient payment. During the median interval of two periods according to the laparoscopic surgery learning curve, there was an inflation rate of about 10% on the medical charges such as operation, radiology, laboratory, and admission fee.


RESULTS
Operating room costs were significantly higher after LAP during the two periods, but the median difference between LAP and OS decreased during the experienced period ($3,055 to $1,850). With increasing operative experience in LAP, the OR-related hospital deficit improved (-$1,072 to-$840). Total hospital charges were significantly higher for LAP than for OS in the early learning period (p < 0.05), but they were similar in the experienced period ($7,983/patient versus $7,045/patient, p > 0.05). During the experienced period, patients paid a lower surcharge for LAP ($1,885-$1,118).


CONCLUSIONS
Total hospital charges for laparoscopic surgery were substantially higher than those of open surgery during the early learning period, but become similar during the experienced period. The shortening of the learning period is a critical factor for achieving cost-effective laparoscopic surgery.
Park
Jun-Seok
JS
Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Seoul, Korea.
Kang
Sung-Bum
SB
Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Seoul, Korea. kangsb@snubh.org.|Department of Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, 110-744, Seoul, Korea. kangsb@snubh.org.
Kim
Sung-Wook
SW
Department of Cost Management, Seoul National University Bundang Hospital, 300 Gumi- dong Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Seoul, Korea.
Cheon
Gui-Neum
GN
Department of Insurance Nurses, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Seoul, Korea.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D005260:Female; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D007723:Korea; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D007813:Laparotomy / Q000191:economics* / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000191:economics; D012004:Rectal Neoplasms / Q000191:economics* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012811:Sigmoid Neoplasms / Q000191:economics* / Q000601:surgery*; D016896:Treatment Outcome