title: Effect of laparoscopic surgery on health care utilization and costs in patients who undergo colectomy.
abstract: OBJECTIVE
  Laparoscopic colectomy is safe and effective in the treatment of many colorectal diseases. However, the effect of increasing use of laparoscopy on overall health care utilization and costs, especially in the long term, has not been thoroughly investigated.
  
  
  OBJECTIVE
  To evaluate the effect of laparoscopic vs open colectomy on short- and long-term health care utilization and costs.
  
  
  METHODS
  Retrospective multivariate regression analysis of national health insurance claims data was used to evaluate health care utilization and costs up to 1 year following elective colectomy. Data were obtained from the Truven Health Analytics MarketScan Commercial Claims and Encounters database. Patients aged 18 to 64 years who underwent elective laparoscopic or open colectomy from January 1, 2010, through December 31, 2010, were included. Patients with complex diagnoses that require increased non-surgery-related health care utilization, including malignant neoplasm, inflammatory bowel disease, human immunodeficiency virus, transplantation, and pregnancy, were excluded. Of 25 481 patients who underwent colectomy, 4160 were included in the study.
  
  
  METHODS
  Healthcare utilization, including office, hospital outpatient, and emergency department visits and inpatient services 90 and 365 days after the index procedure; total health care costs; and estimated days off from work owing to health care utilization.
  
  
  RESULTS
  Of 25 481 patients who underwent colectomy, 4160 were included in the study (laparoscopic, 45.6%; open, 54.4%). The mean (SD) net and total payments were lower for laparoscopy ($23 064 [$14 558] and $24 196 [$14 507] vs $29 753 [$21 421] and $31 606 [$23 586]). In the first 90 days after surgery, an open approach was significantly associated with a 1.26-fold increase in health care costs (estimated, $1715; 95% CI, $338-$2853), increased use of heath care services, and more estimated days off from work (2.78 days; 95% CI, 1.93-3.59). Similar trends were found in the full postoperative year, with an estimated 1.18-fold increase (95% CI, 1.04-1.35) in health care expenditures and an increase of 1.15 times (95% CI, 1.08-1.23) the number of health care utilization days compared with laparoscopy.
  
  
  CONCLUSIONS
  Laparoscopic colectomy results in a significant reduction in health care costs and utilization in the short- and long-term postoperative periods.
authors: Department of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio.
authors: Benjamin P
authors: BP
authors: Crawshaw
authors: Data and Analytic Resources, Covidien, Mansfield, Massachusetts.
authors: Hung-Lun
authors: HL
authors: Chien
authors: Department of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio3Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway.
authors: Knut M
authors: KM
authors: Augestad
authors: Department of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio.
authors: Conor P
authors: CP
authors: Delaney
mesh_terms: D000293:Adolescent; D000328:Adult; D003082:Colectomy / Q000191:economics / Q000379:methods*; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult