title: Does the learning curve during laparoscopic colectomy adversely affect costs?
abstract: BACKGROUND
  This study aimed to investigate whether the learning curve during laparoscopic colectomy is associated with increased costs compared with the procedure after the learning curve has been achieved.
  
  
  METHODS
  The direct costs for patients undergoing laparoscopic colectomy during the learning curve (group A) and after the attainment of proficiency by two colorectal surgeons performing the procedure (group B) between 2001 and 2007 were compared. The learning curve was defined as the first 40 laparoscopic colectomy cases for each surgeon. The distribution of cases for the surgeons ensured that cost-related differences were not influenced by lead time bias of cases performed during the learning curve.
  
  
  RESULTS
  The study involved 80 group A and 74 group B patients. Groups A and B were similar in terms of age (P = 0.7), gender (P = 0.5), American Society of Anesthesiologists (ASA) score (P = 0.5), body mass index (P = 0.3), diagnosis (P = 0.8), previous abdominal surgery (P = 0.07), and comorbidity (P = 0.4). The two groups also were similar with regard to performance of anastomosis (P = 0.2) or resection (P = 0.6), conversion to open surgery (P = 0.7), postoperative morbidity (P = 0.6), readmission (P = 0.1), reoperation rate (P = 0.6), and hospital length of stay (P = 0.6). The operation time was significantly longer for group A (P = 0.01). The total direct costs (P = 0.7) and the operating room (P = 0.6), nursing (P = 0.7), pharmacy (P = 0.9), radiology (P = 1), and professional (P = 0.051) costs were however similar between the two groups.
  
  
  CONCLUSIONS
  As expected, laparoscopic colectomy during the learning curve period is associated with prolonged operating time. Concerns pertaining to increased conversions, complications, and direct costs during this period were not substantiated in this study.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Digestive Disease Institute-A30, 9500 Euclid Avenue, Cleveland, OH 44195, USA. kiranp@ccf.org
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
authors.forename: Hasan T
authors.initials: HT
authors.lastname: Kirat
authors.forename: Ersin
authors.initials: E
authors.lastname: Ozturk
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Geisler
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
mesh_terms: D003082:Colectomy / Q000009:adverse effects / Q000191:economics* / Q000193:education*; D004180:Direct Service Costs; D005260:Female; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics* / Q000193:education*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged