title: Cost comparison analysis of open versus laparoscopic distal pancreatectomy.
abstract: BACKGROUND
  In comparison with open distal pancreatectomy (ODP), laparoscopic distal pancreatectomy (LDP) is associated with fewer complications and shorter hospital stays, but comparative cost data for the two approaches are limited.
  
  
  METHODS
  Records of all distal pancreatectomies carried out from January 2009 to June 2013 were reviewed and stratified according to operative complexity. Patient factors and outcomes were recorded. Total variable costs (TVCs) were tabulated for each patient, and stratified by category [e.g. 'floor', 'operating room' (OR), 'radiology']. Costs for index admissions and 30-day readmissions were compared between LDP and ODP groups.
  
  
  RESULTS
  Of 153 procedures, 115 (70 LDP, 45 ODP) were selected for analysis. The TVC of the index admission was US$3420 less per patient in the LDP group (US$10 480 versus US$13 900; P = 0.06). Although OR costs were significantly greater in the LDP cohort (US$5756 versus US$4900; P = 0.02), the shorter average hospitalization in the LDP group (5.2 days versus 7.7 days; P = 0.01) resulted in a lower overall cost. The total cost of index hospitalization combined with readmission was significantly lower in the LDP cohort (US$11 106 versus US$14 803; P = 0.05).
  
  
  CONCLUSIONS
  In appropriately selected patients, LDP is more cost-effective than ODP. The increased OR cost associated with LDP is offset by the shorter hospitalization. These data clarify targets for further cost reductions.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Rutz
authors.forename: Malcolm H
authors.initials: MH
authors.lastname: Squires
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.forename: Juan M
authors.initials: JM
authors.lastname: Sarmiento
authors.forename: Joanna W
authors.initials: JW
authors.lastname: Etra
authors.forename: Sebastian D
authors.initials: SD
authors.lastname: Perez
authors.forename: William
authors.initials: W
authors.lastname: Knechtle
authors.forename: Kenneth
authors.initials: K
authors.lastname: Cardona
authors.forename: Maria C
authors.initials: MC
authors.lastname: Russell
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley
authors.forename: John F
authors.initials: JF
authors.lastname: Sweeney
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
mesh_terms: D000328:Adult; D000368:Aged; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000191:economics; D010180:Pancreatectomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D010359:Patient Readmission / Q000191:economics; D018579:Patient Selection; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome