title: Impact of minimally invasive surgery on medical spending and employee absenteeism.
abstract: OBJECTIVE
  As many surgical procedures have undergone a transition from a standard, open surgical approach to a minimally invasive one in the past 2 decades, the diffusion of minimally invasive surgery may have had sizeable but overlooked effects on medical expenditures and worker productivity.
  
  
  OBJECTIVE
  To examine the impact of standard vs minimally invasive surgery on health plan spending and workplace absenteeism for 6 types of surgery.
  
  
  METHODS
  Cross-sectional regression analysis.
  
  
  METHODS
  National health insurance claims data and matched workplace absenteeism data from January 1, 2000, to December 31, 2009.
  
  
  METHODS
  A convenience sample of adults with employer-sponsored health insurance who underwent either standard or minimally invasive surgery for coronary revascularization, uterine fibroid resection, prostatectomy, peripheral revascularization, carotid revascularization, or aortic aneurysm repair.
  
  
  METHODS
  Health plan spending and workplace absenteeism from 14 days before through 352 days after the index surgery.
  
  
  RESULTS
  There were 321,956 patients who underwent surgery; 23,814 were employees with workplace absenteeism data. After multivariable adjustment, mean health plan spending was lower for minimally invasive surgery for coronary revascularization (-$30,850; 95% CI, -$31,629 to -$30,091), uterine fibroid resection (-$1509; 95% CI, -$1754 to -$1280), and peripheral revascularization (-$12,031; 95% CI, -$15,552 to -$8717) and higher for prostatectomy ($1350; 95% CI, $611 to $2212) and carotid revascularization ($4900; 95% CI, $1772 to $8370). Undergoing minimally invasive surgery was associated with missing significantly fewer days of work for coronary revascularization (mean difference, -37.7 days; 95% CI, -41.1 to -34.3), uterine fibroid resection (mean difference, -11.7 days; 95% CI, -14.0 to -9.4), prostatectomy (mean difference, -9.0 days; 95% CI, -14.2 to -3.7), and peripheral revascularization (mean difference, -16.6 days; 95% CI, -28.0 to -5.2).
  
  
  CONCLUSIONS
  For 3 of 6 types of surgery studied, minimally invasive procedures were associated with significantly lower health plan spending than standard surgery. For 4 types of surgery, minimally invasive procedures were consistently associated with significantly fewer days of absence from work.
authors.affiliation: Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, US Department of Veterans Affairs, Philadelphia, Pennsylvania, USA. eandrew@mail.med.upenn
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Epstein
authors.forename: Peter W
authors.initials: PW
authors.lastname: Groeneveld
authors.forename: Michael O
authors.initials: MO
authors.lastname: Harhay
authors.forename: Feifei
authors.initials: F
authors.lastname: Yang
authors.forename: Daniel
authors.initials: D
authors.lastname: Polsky
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000706:statistics & numerical data; D016894:Endarterectomy, Carotid / Q000379:methods; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics* / Q000706:statistics & numerical data*; D057216:Propensity Score; D011468:Prostatectomy / Q000191:economics / Q000379:methods; D014481:United States; D063186:Uterine Myomectomy / Q000191:economics / Q000379:methods; D055815:Young Adult