Cost analysis of laparoscopic versus open colectomy in patients with colon cancer: results from a large nationwide population database.
Laparoscopic colectomy (LC) is a safe and reliable option for patients with colon cancer. This study examined factors associated with LC use and cost differences between LC and open colectomy (OC). Using the Cost & Utilization Project National Inpatient Sample database (2008), patients  with colon cancer undergoing elective LC or OC were selected. Chi square and Mann-Whitney tests were used to assess differences between LC and OC. Logistic and multiple regression analysis was used to determine variables associated with LC and predictors of cost. All analysis was weighted.  A total of 63,950 patients were identified (LC 8.1%, OC 91.9%). The majority was female (52.7%), white (61.4%), using Medicare (61.1%), and had surgery performed at a large (64.2%), nonteaching (56.9%), urban (87.3%) hospital in the South (37.7%). Mean age was 70 years. On unadjusted analysis,  LC was associated with a lower mortality rate (1.7 vs 2.4%), fewer complications (18.9 vs 27.1%), shorter length of stay (5 vs 7 days), and lower total charges ($41,971 vs $43,459, all P < 0.001). LC is a less expensive but less popular surgical  option for colon cancer. Stage, race, Charlson score, teaching status, location, and hospital size influence the use of a laparoscopic approach. LC is associated with fewer complications and decreased mortality which contribute to its lower cost as compared with OC.
Department of Surgery, York Hospital, York, Pennsylvania, USA. drvaid@yahoo.com
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D000328:Adult; D000368:Aged; D003082:Colectomy / Q000191:economics* / Q000379:methods; D003110:Colonic Neoplasms / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000191:economics*; D007813:Laparotomy / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D055815:Young Adult