title: A cost comparison of laparoscopic and open colon surgery in a publicly funded academic institution.
abstract: BACKGROUND
  The objective of this study was to compare the total hospital cost of laparoscopic (lap) and open colon surgery at a publicly funded academic institution.
  
  
  METHODS
  Patients undergoing elective laparoscopic or open colon surgery for all indications at the University Health Network, Toronto, Canada, from April 2004 to March 2009 were included. Patient demographic, operative, and outcome data were reviewed retrospectively. Hospital costs were determined from the Ontario Case Costing Initiative, adjusted for inflation, and compared using the Mann-Whitney U test. Linear regression was used to analyze the relationship between length of stay and total hospital cost.
  
  
  RESULTS
  There were 391 elective colon resections (223 lap/168 open, 15.4 % conversion). There was no difference in median age, gender, or Charlson score. Body mass index was slightly higher for laparoscopic surgery (27.5/25.9 lap/open; p = 0.008), while the American Society of Anesthesiologists score was slightly higher for open surgery. Median operative time was greater for laparoscopic surgery (224/196 min, lap/open; p = 0.001). There was no difference in complication rates (21.6/22.5 % lap/open; p = 0.900), reoperations (5.8/6.5 % lap/open; p = 0.833) or 30-day readmissions (7.6/12.5 % lap/open; p = 0.122). Number of emergency room visits was greater with open surgery (12.6/20.8 % lap/open; p = 0.037). Operative cost was higher for laparoscopic surgery ($4,171.37/3,489.29 lap/open; p = 0.001), while total hospital cost was significantly reduced ($9,600.22/12,721.41 lap/open; p = 0.001). Median length of stay was shorter for laparoscopic surgery (5/7 days lap/open; p = 0.000), and this correlated directly with hospital cost.
  
  
  CONCLUSIONS
  Laparoscopic colon surgery is associated with increased operative costs but significantly lower total hospital costs. The cost savings is related, in part, to reduced length of stay with laparoscopic surgery.
authors.affiliation: Department of Surgery, University of Manitoba, Winnipeg, MB, Canada, krista.hardy@yahoo.ca.
authors.forename: Krista M
authors.initials: KM
authors.lastname: Hardy
authors.forename: Josephine
authors.initials: J
authors.lastname: Kwong
authors.forename: Kristen B
authors.initials: KB
authors.lastname: Pitzul
authors.forename: Ashley S
authors.initials: AS
authors.lastname: Vergis
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Jackson
authors.forename: David R
authors.initials: DR
authors.lastname: Urbach
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
mesh_terms: D000047:Academies and Institutes / Q000191:economics*; D000368:Aged; D002170:Canada; D003082:Colectomy / Q000191:economics* / Q000379:methods; D003108:Colonic Diseases / Q000191:economics / Q000601:surgery*; D003365:Costs and Cost Analysis; D017558:Elective Surgical Procedures / Q000191:economics; D005260:Female; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D012189:Retrospective Studies; D018709:Statistics, Nonparametric