title: Cost-effectiveness of laparoscopy in rectal cancer.
abstract: BACKGROUND
  There is an increasing trend to use laparoscopy for rectal cancer surgery. Although laparoscopic and open rectal resections appear oncologically equivalent, there is little information on the cost of different surgical approaches. With the current health care crisis and the importance of optimizing health care resources and patient outcomes, the cost of care is an important factor.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the cost-effectiveness of laparoscopy in rectal cancer.
  
  
  METHODS
  This was a case-matched study.
  
  
  METHODS
  This study was conducted at a tertiary referral center.
  
  
  METHODS
  Patients undergoing elective rectal cancer resection between 2007 and 2012 were selected.
  
  
  METHODS
  A review of a prospective database for elective laparoscopic rectal cancer resections was performed. Laparoscopic cases were matched to open cases based on age, BMI, operative procedure, and diagnostic-related group.
  
  
  METHODS
  The primary outcomes measured were the cost of care, hospital length of stay, discharge disposition, readmission, postoperative complications, and mortality rates.
  
  
  RESULTS
  Two hundred fifty-four matched cases were included in the analysis: 125 laparoscopic (49%) and 129 open (51%). The cTNM stage (p = 0.39), tumor distance from the anal verge (p = 0.07), and rate of neoadjuvant therapy received between the laparoscopic and open groups were similar (p = 0.12). Operating time (p< 0.01) and cost per operating room minute (p = 0.04) were significantly higher in the open group. The groups were oncologically equivalent, based on circumferential resection margin (p = 0.15). The laparoscopic group had a significantly shorter length of stay (p < 0.01) and lower total hospital cost (p < 0.01). Postoperative complications, 30-day readmission, reoperation, and mortality rates were similar. However, significantly more patients undergoing open resection required intensive care unit care (p = 0.03), skilled nursing (p = 0.03), or home care services (p < 0.01) at discharge.
  
  
  CONCLUSIONS
  This investigation was conducted at a single institution and it is a retrospective study with potential bias.
  
  
  CONCLUSIONS
  Laparoscopy is cost-effective for rectal cancer surgery, improving both health care expenditures and patient outcomes. For selected patients, laparoscopic rectal cancer resection can reduce length of stay, operating time, and resource utilization.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Keller
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Champagne
authors.forename: Harry L
authors.initials: HL
authors.lastname: Reynolds
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Stein
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D011183:Postoperative Complications / Q000191:economics; D012004:Rectal Neoplasms / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies