Multicenter Stratified Comparison of Hospital Costs Between Laparoscopic and Open Colorectal Cancer Resections: Influence of Tumor Location and Operative Risk.
To compare actual 90-day hospital costs between elective open and laparoscopic colon and rectal cancer resection in a daily practice multicenter setting stratified for operative risk.



Laparoscopic resection has developed as a commonly accepted surgical procedure for colorectal cancer. There are conflicting data on the influence of laparoscopy on hospital costs, without separate analyses based on operative risk.



Retrospective analyses using a population-based database (Dutch Surgical Colorectal Audit). All elective resections for a T1-3N0-2M0 stage colorectal cancer were included between 2010 and 2012 in 29 Dutch hospitals. Operative risk was stratified for age (<75 years or ≥75 years) and ASA status (I-II/III-IV). Ninety-day hospital costs were measured uniformly in all hospitals based on time-driven activity-based costing.



Total 90-day hospital costs ranged from &OV0556;10474 to &OV0556;20865 in the predefined subgroups. For colon cancer surgery (N = 4202), laparoscopic resection was significant less expensive than open resection in all subgroups, savings because of laparoscopy ranged from &OV0556;409 (<75 years ASA I-II) to &OV0556;1932 (≥75 years ASA I-II). In patients ≥75 years and ASA I-II, laparoscopic resection was associated with 46% less mortality (P = 0.05), 41% less severe complications (P < 0.001), 25% less hospital stay (P = 0.013), and 65% less ICU stay (P < 0.001). For rectal cancer surgery (N=2328), all laparoscopic subgroups had significantly higher total hospital costs, ranging from &OV0556;501 (<75 years ASA I-II) to &OV0556;2515 (≥75 years ASA III-IV).



Laparoscopic resection resulted in the largest cost reduction in patients over 75 years with ASA I-II undergoing colonic resection, and the largest cost increase in patients over 75 years with ASA III-IV undergoing rectal resection as compared with an open approach.
*Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands †Department of Surgery, Groene Hart Ziekenhuis, Gouda, The Netherlands ‡Department of Medical Statistics and Bioinformatics, Leiden University Mathematical Institute, Leiden University Medical Center, Leiden, The Netherlands §Performation, Bilthoven, The Netherlands ¶X-IS, Delft, The Netherlands ||Department of Surgery, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands **Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands ††Department of Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands ‡‡Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Johannes A
JA
Govaert
Marta
M
Fiocco
Wouter A
WA
van Dijk
Nikki E
NE
Kolfschoten
Hubert A
HA
Prins
Jan-Willem T
JWT
Dekker
Rob A E M
RAEM
Tollenaar
Pieter J
PJ
Tanis
Michel W J M
MWJM
Wouters
D000368:Aged; D003082:Colectomy / Q000191:economics* / Q000379:methods; D003110:Colonic Neoplasms / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D008485:Medical Audit; D009426:Netherlands; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors