title: A national evaluation of clinical and economic outcomes in open versus laparoscopic colorectal surgery.
abstract: Surgical value is based on optimizing clinical and financial outcomes. The clinical benefits of laparoscopic surgery are well established; however, many patients are still not offered a laparoscopic procedure. Our objective was to compare the modern clinical and financial outcomes of laparoscopic and open colorectal surgery.
  
  
  
  The Premier Perspective database identified patients undergoing elective colorectal resections from January 1, 2013 to December 31, 2013. Cases were stratified by operative approach into laparoscopic and open cohorts. Groups were controlled on all demographics, diagnosis, procedural, hospital characteristics, surgeon volume, and surgeon specialty and then compared for clinical and financial outcomes. The main outcome measures were length of stay (LOS), complications, readmission rates, and cost by surgical approach.
  
  
  
  A total of 6343 patients were matched and analyzed in each cohort. The most common diagnosis was diverticulitis (p = 0.0835) and the most common procedure a sigmoidectomy (p = 0.0962). The LOS was significantly shorter in laparoscopic compared to open (mean 5.78 vs. 7.80 days, p < 0.0001). The laparoscopic group had significantly lower readmission (5.82 vs. 7.68 %, p < 0.0001), complication (32.60 vs. 42.28 %, p < 0.0001), and mortality rates (0.52 vs. 1.28 %, p < 0.0001). The total cost was significantly lower in laparoscopic than in open (mean $17,269 vs. $20,552, p < 0.0001). By category, laparoscopy was significantly more cost-effective for pharmacy (p < 0.0001), room and board (p < 0.0001), recovery room (p = 0.0058), ICU (p < 0.0001), and laboratory and imaging services (both p < 0.0001). Surgical supplies (p < 0.0001), surgery (p < 0.0001), and anesthesia (p = 0.0053) were higher for the laparoscopic group.
  
  
  
  Laparoscopy is more cost-effective and produces better patient outcomes than open colorectal surgery. Minimally invasive colorectal surgery is now the standard that should be offered to patients, providing value to both patient and provider.
authors.affiliation: Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA. debby_keller@hotmail.com.|Division of Colon and Rectal Surgery, Houston Methodist Hospital, Houston, TX, USA. debby_keller@hotmail.com.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Keller
authors.affiliation: University Hospitals-Case Medical Center, Cleveland, OH, USA.
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
authors.affiliation: Healthcare Outcomes and Research, Covidien, Mansfield, MA, USA.
authors.forename: Lobat
authors.initials: L
authors.lastname: Hashemi
authors.affiliation: Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA.|Division of Colon and Rectal Surgery, Houston Methodist Hospital, Houston, TX, USA.|Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Haas
mesh_terms: D000368:Aged; D003082:Colectomy / Q000191:economics / Q000379:methods*; D012809:Colon, Sigmoid / Q000601:surgery; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D004238:Diverticulitis / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007813:Laparotomy / Q000191:economics / Q000379:methods; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000379:methods; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology*; D016896:Treatment Outcome; D014481:United States
keywords: Financial analysis; Laparoscopic colorectal surgery; Patient outcomes; Surgical quality