title: Cost-efficiency and outcomes in the treatment of perforated peptic ulcer disease: laparoscopic versus open approach.
abstract: OBJECTIVE
  Laparoscopic treatment of perforated peptic ulcer disease (perfPUD) has demonstrated comparable operative outcomes with an open approach though the cost-efficiency of this method has not been studied.
  
  
  METHODS
  Data were obtained from the Nationwide Inpatient Sample (2007-2010). Patients who underwent operation for perfPUD were divided on the basis of laparoscopic or open approach. The primary outcome measures were hospital duration of stay, mortality, and total charges.
  
  
  RESULTS
  A total of 5,361 patients with perfPUD were identified: 5,219 in the open group and 142 in the laparoscopic group. Patients in the laparoscopic group were younger (50.5 vs 60.0, P < .001) and had a lesser incidence at presentation of sepsis (8.5 vs 14.8%, P = .034) and shock (2.1 vs 7.7%, P = .012). On univariate analysis, the laparoscopic group had decreased duration of stay (7.0 vs 8.0 days, P < .001), lesser rates of mortality (3.5 vs 8.1%, P = .048), and were discharged to home more frequently (79.6 vs 68.1%, P = .025). Mean total charges were less in the laparoscopic group ($44,095 vs $52,055, P = .019). Multivariate analyses failed to show a difference between groups for any of the outcome variables.
  
  
  CONCLUSIONS
  The laparoscopic treatment of perfPUD is associated with equivalent costs and outcomes compared with the open technique when we corrected for presentation variables.
authors.affiliation: General Surgery Residency Program, Grand Rapids Medical Education Partners, Grand Rapids, MI; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI. Electronic address: paul.wright@grmep.com.
authors.forename: G Paul
authors.initials: GP
authors.lastname: Wright
authors.affiliation: Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI; Research Department, Grand Rapids Medical Education Partners, Grand Rapids, MI.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Davis
authors.affiliation: Research Department, Grand Rapids Medical Education Partners, Grand Rapids, MI.
authors.forename: Tracy J
authors.initials: TJ
authors.lastname: Koehler
authors.affiliation: General Surgery Residency Program, Grand Rapids Medical Education Partners, Grand Rapids, MI; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI; Division of Surgical Specialties, Spectrum Health Medical Group, Grand Rapids, MI.
authors.forename: David E
authors.initials: DE
authors.lastname: Scheeres
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000401:mortality; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010439:Peptic Ulcer Perforation / Q000191:economics / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States