title: Laparoscopic versus open distal pancreatectomy: a clinical and cost-effectiveness study.
abstract: BACKGROUND
  Laparoscopic distal pancreatectomy (LDP) is being increasingly performed with some concerns regarding the cost of the minimally invasive approach. The purpose of this study was to assess the cost-effectiveness of LDP versus open distal pancreatectomy (ODP).
  
  
  METHODS
  A retrospective clinical and cost-comparison analysis was performed for patients who underwent LDP vs. OPD between 2005 and 2011. Data considered for the comparison analysis were: operative costs (surgical procedure, operative time, blood transfusions), postoperative costs (laboratory testing, hospital stay, complication management, readmissions), and overall costs.
  
  
  RESULTS
  Fifty-one distal pancreatectomies (laparoscopic = 35, open = 16) were performed during the study period. The median operative time was 200 (range, 120-420) min for LDP vs. 225 (range, 120-460) min for ODP (p = 0.93). Median blood loss was 200 (range, 50-900) mL for LDP vs. 394 (range, 75-2000) mL for ODP (p = 0.038). Median hospital stay was 7 (range, 3-25) days in the laparoscopic group vs. 11 (range, 5-46) days in the open group (p = 0.007). Complication rate was 40% for LDP vs. 69% in ODP (p = 0.075). Postoperative intervention was required in 11% of patients after LDP vs. 31% after ODP (p = 0.12). The average operative, postoperative, and overall cost was £6039 (range, £4276-£9500), £4547 (range, £1299-£13937), £10587 (range, £6508-£20303) vs. £5231 (range, £3409-£9330), £10094 (range, £2665-£39291), £15324 (range, £7209-£47484) for the LDP and ODP groups, respectively (p = 0.033; p = 0.006; p = 0.197).
  
  
  CONCLUSIONS
  We showed that LDP is feasible and safe without having a negative impact on cost. Extensive experience in pancreatic and laparoscopic surgery is required to optimize surgical outcomes.
authors.affiliation: Hepatobiliary-Pancreatic and Laparoscopic Surgical Unit, Southampton University Hospitals NHS Foundation Trust, Southampton, UK. abu_hlal@yahoo.com
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abu Hilal
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hamdan
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Fabio
authors.forename: Neil W
authors.initials: NW
authors.lastname: Pearce
authors.forename: Colin D
authors.initials: CD
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000191:economics; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000191:economics / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000191:economics / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult