title: Comparison of outcomes and costs between laparoscopic distal pancreatectomy and open resection at a single center.
abstract: BACKGROUND
  The cost implications of laparoscopic distal pancreatectomy (LDP) and a detailed breakdown of hospital expenditures has not been presented in the literature to date. This study aimed to compare hospital costs and short-term clinical outcomes between LDP and open distal pancreatectomy (ODP).
  
  
  METHODS
  The authors evaluated all the distal pancreatic resections performed at their center between January 2004 and March 2010. Parametric and nonparametric statistical analysis was used to compare hospital departmental and total hospital costs as well as oncologic and surgical outcomes.
  
  
  RESULTS
  A total of 118 cases (42 laparoscopic resections, including 5 conversions, and 76 open resections) were analyzed. The demographic characteristics were similar between the groups except for a predominance of females in the laparoscopic group (P = 0.036). The indications for surgery differed by a paucity of malignant tumors being approached laparoscopically (P < 0.001). Intraoperatively, there were no differences in estimated blood loss, operating room time, or transfusion requirement. The pathologic outcomes did not differ significantly. The median hospital length of stay (LOS) was 5 days (range 3-31 days) for the LDP cohort and 7 days (range 4-19 days) for the ODP cohort (P < 0.001). Postoperative pancreatic fistula occurred for 22 patients, with a higher proportion observed in the LDP group (28.57%; n = 12) than in the open group (13.16%; n = 10; P = 0.05). However, the rates for grade B and higher grade fistula were higher in the ODP group (0 LDP and 4 ODP). The median preadmission and operative costs did not differ significantly. The ODP cohort had significantly higher costs in all other hospital departments, including the total cost.
  
  
  CONCLUSIONS
  LDP is both a cost-effective and safe approach for distal pancreatic lesions. This series showed a shorter LOS and lower total hospital costs for LDP than for ODP, accompanied by equivalent postoperative outcomes.
authors.affiliation: Division of General Surgery, University Health Network, 10E212 Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. adrianmfox@gmail.com
authors.forename: Adrian M
authors.initials: AM
authors.lastname: Fox
authors.forename: Kristen
authors.initials: K
authors.lastname: Pitzul
authors.forename: Faizal
authors.initials: F
authors.lastname: Bhojani
authors.forename: Max
authors.initials: M
authors.lastname: Kaplan
authors.forename: Carol-Anne
authors.initials: CA
authors.lastname: Moulton
authors.forename: Alice C
authors.initials: AC
authors.lastname: Wei
authors.forename: Ian
authors.initials: I
authors.lastname: McGilvray
authors.forename: Sean
authors.initials: S
authors.lastname: Cleary
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D007902:Length of Stay; D008297:Male; D010180:Pancreatectomy / Q000191:economics* / Q000379:methods; D010185:Pancreatic Fistula / Q000191:economics / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000191:economics / Q000601:surgery*; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D055815:Young Adult