Comparison of laparoscopic and open colonic resection within fast-track and traditional perioperative care pathways: Clinical outcomes and in-hospital costs.
BACKGROUND
This study examined short-term clinical outcomes and in-hospital costs of laparoscopic and open colonic resection within fast-track and traditional care pathways.


METHODS
A case-control study was performed. From 2007 to 2009, 116 patients underwent laparoscopic or open colonic resection for benign or malignant disease within fast-track care pathway. The control group consisted of 116 age-, sex-, comorbidity-, type of surgery-, and diagnosis-matched patients who received a traditional perioperative care from 2000 to 2007. The main measures of outcome were postoperative hospital stay and in-hospital costs, with 30-day mortality, morbidity, reoperation, and readmission rates as secondary outcomes.


RESULTS
The study groups were well balanced for baseline characteristics. Postoperative hospital stay was shorter in the fast-track than in the control group: laparoscopic resection median 3 versus 5 days (p < 0.001) and open resection 4 versus 7 days (p < 0.001). In multivariate analysis fast-track care, laparoscopic surgery and complications were independent determinants affecting the length of hospital stay. Overall, there was a trend toward lower in-hospital costs in the fast-track group compared with the traditional care group, but the difference was not statistically significant. Open surgery within fast-track care was the least costly option compared to laparoscopic or open surgery within traditional care but not significantly so when compared with laparoscopy within fast-track care. Intake of solid food and bowel function recovered 1 day earlier in the fast-track group than in the control group (p < 0.001). Complications were more frequent after open surgery than after laparoscopic surgery (23.3% vs 11.0%, p = 0.012). Reoperation and readmission rates were similar between the study groups.


CONCLUSIONS
Laparoscopy improves the efficiency of fast-track perioperative care without significantly increasing in-hospital costs.
Department of Surgery, Central Hospital of Central Finland, Jyväskylä, Finland.
A
A
Ehrlich
Jyväskylä University School of Business and Economics, Jyväskylä, Finland.
S
S
Kellokumpu
Department of Anesthesiology, Central Hospital of Central Finland, Jyväskylä, Finland.
B
B
Wagner
Department of General Practice, Primary Health Care Unit, Turku University Hospital, Turku, Finland Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland.
H
H
Kautiainen
Department of Surgery, Central Hospital of Central Finland, Jyväskylä, Finland ilmo.kellokumpu@ksshp.fi.
I
I
Kellokumpu
D003082:Colectomy / Q000191:economics / Q000379:methods*; D003108:Colonic Diseases / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D007902:Length of Stay / Q000191:economics / Q000639:trends; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010359:Patient Readmission / Q000191:economics; D019990:Perioperative Care / Q000191:economics*; D012086:Reoperation / Q000191:economics; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
Laparoscopy; colon; fast-track