The Burden of Gastrointestinal Anastomotic Leaks: an Evaluation of Clinical and Economic Outcomes

Objective

To evaluate the clinical and economic burden associated with anastomotic leaks following colorectal surgery.

Methods

Retrospective data (January 2008 to December 2010) were analyzed from patients who had colorectal surgery with and without postoperative leaks, using the Premier Perspective? database. Data on in-hospital mortality, length of stay (LOS), re-admissions, postoperative infection, and costs were analyzed using univariate and multivariate analyses, and the propensity score matching (PSM) and generalized linear models (GLM).

Results

Of the patients, 6,174 (6.18 %) had anastomotic leaks within 30 days after colorectal surgery. Patients with leaks had 1.3 times higher 30-day re-admission rates and 0.8–1.9 times higher postoperative infection rates as compared with patients without leaks (P?<?0.001 for both). Anastomotic leaks incurred additional LOS and hospital costs of 7.3 days and $24,129, respectively, only within the first hospitalization. Per 1,000 patients undergoing colorectal surgery, the economic burden associated with anastomotic leaks—including hospitalization and re-admission—was established as 9,500 days in prolonged LOS and $28.6 million in additional costs. Similar results were obtained from both the PSM and GLM for assessing total costs for hospitalization and re-admission.

Conclusions

Anastomotic leaks in colorectal surgery increase the total clinical and economic burden by a factor of 0.6–1.9 for a 30-day re-admission, postoperative infection, LOS, and hospital costs.     

Endoscopic bursectomy for the treatment of septic pre-patellar bursitis: a case series

Introduction

Operative treatment for septic pre-patellar bursitis generally involves open debridement in addition to an extended course of intravenous antibiotics. Skin necrosis and wound breakdown are potential complications of this procedure in addition to scar sensitivity and a prolonged recovery.

Method

We report endoscopic bursectomy for the treatment of septic pre-patellar bursitis in eight patients over a 3-year period. All patients had microbiological confirmation of an infective process. The average age was 36?years (23–68?years). The average hospital stay was 6?days (4–9?days).

Results

No patient had a recurrence or complained of tenderness or hypoaesthesia around their wound. No patient experienced wound complications or skin necrosis. The average return to work time was 18?days (7–22?days).

Conclusion

We conclude that endoscopic bursectomy is a safe and effective treatment for septic pre-patellar bursitis with a shortened hospital stay and a quicker return to work than conventional open debridement.     

Usefulness of an enhanced recovery after surgery protocol for perioperative management following open repair of an abdominal aortic aneurysm

Purpose

To achieve early recovery and early discharge from the hospital by applying an enhanced recovery after surgery (ERAS) protocol, which is mainly used with colonic surgery, for the perioperative management of open AAA surgery.

Method

One hundred twenty-seven open AAA surgery cases successfully carried out between 2003 and 2011 were included in this study. The ERAS protocol was used for the cases from April 2008 onward, and we performed a comparison of the conventionally treated cases with ERAS cases regarding the start of postoperative oral consumption, the postoperative hospital stay, and hospitalization medical costs.

Results

The time to restarting oral consumption and the postoperative hospital stay were significantly shorter for the ERAS group (n?=?52) compared to the conventionally managed group (n?=?75); with values of 59?±?15 and 93?±?25?h (p?=?0.021), 9?±?3 and 16?±?5?days (p?=?0.001), respectively. The medical costs for the ERAS group were 92?% of the costs of the conventionally managed group.

Conclusion

Use of the ERAS protocol for the perioperative management of open AAA surgery shortened the time before recommencing oral consumption, the postoperative hospital stay, and reduced the medical costs compared to the conventional approach.     

Safety of postoperative thromboprophylaxis after major hepatobiliary–pancreatic surgery in Japanese patients

Background and purpose

Thromboprophylaxis is recommended for preventing postoperative venous thromboembolism (VTE) after abdominal surgery; however, its use after major hepatobiliary–pancreatic surgery is typically avoided as it increases the risk of bleeding. We conducted this study to evaluate the safety of thromboprophylaxis after major hepatobiliary–pancreatic surgery.

Methods

We analyzed the rates of postoperative bleeding, VTE, morbidity, and prolonged hospital stay in 349 patients who underwent major hepatobiliary–pancreatic surgery, such as pancreaticoduodenectomy, hemihepatectomy or greater, and hepatopancreaticoduodenectomy.

Results

Chemical thromboprophylaxis was associated with significantly increased rates and risks of overall bleeding events vs. no chemical thromboprophylaxis (26.6 vs. 8.5 %, respectively). The rate of minor hemorrhage was significantly higher in patients who received chemical thromboprophylaxis (21.7 vs. 3.5 %); however, there were no differences in the rate of major hemorrhage requiring blood transfusion or hemostatic intervention between the groups (4.8 vs. 4.9 %). The postoperative VTE rate was also significantly decreased by chemical thromboprophylaxis (2.9 vs. 7.7 %). However, chemical thromboprophylaxis did not affect the rate of SSI, severe morbidity, or duration of the postoperative hospital stay.

Conclusion

We consider that chemical thromboprophylaxis is beneficial and can be safely used even after major hepatobiliary–pancreatic surgery.     

Establishment of a clinical pathway as an effective tool to reduce hospitalization and charges after video-assisted thoracoscopic pulmonary resection

Objective

The purpose of this study was to assess the effect of establishing a clinical pathway based on the length of hospitalization, hospital charges, and the outcome for video-assisted thoracoscopic pulmonary resection (VATPR).

Methods

We retrospectively analyzed consecutive patients who were diagnosed as having primary lung cancer, metastatic lung cancer, or a nodule that was suspected to be malignant and thus was operated on using VATPR during the 1-year period before (n = 105) and after (n = 113) pathway implementation.

Results

The mean economic cost and total hospital stay before and after pathway implementation were about $14?439 and $13?093 (US), and 29.4 and 18.6 days, respectively. These figures were significantly lower after pathway implementation than before establishment of the pathway.

Conclusion

A clinical pathway is thus considered useful for reducing the length of total hospital stay and the costs associated with VATPR while maintaining high-quality postoperative care.     

Associations of Hospital Length of Stay with Surgical Site Infections

Background

Surgical site infections (SSI) are a major cause of morbidity and mortality in surgical patients. Postoperative and total hospital length of stay (LOS) are known to be prolonged by the occurrence of SSI. Preoperative LOS may increase the risk of SSI. This study aims at identifying the associations of pre- and postoperative LOS in hospital and intensive care with the occurrence of SSI.

Methods

This observational cohort study includes general, orthopedic trauma and vascular surgery patients at two tertiary referral centers in Switzerland between February 2013 and August 2015. The outcome of interest was the 30-day SSI rate.

Results

We included 4596 patients, 234 of whom (5.1%) experienced SSI. Being admitted at least 1 day before surgery compared to same-day surgery was associated with a significant increase in the odds of SSI in univariate analysis (OR 1.65, 95% CI 1.25–2.21, p?<?0.001). More than 1 day compared to 1 day of preoperative hospital stay did not further increase the odds of SSI (OR 1.08, 95% CI 0.77–1.50, p?=?0.658). Preoperative admission to an intensive care unit (ICU) increased the odds of SSI as compared to hospital admission outside of an ICU (OR 2.19, 95% CI 0.89–4.59, p?=?0.057). Adjusting for potential confounders in multivariable analysis weakened the effects of both preoperative admission to hospital (OR 1.38, 95% CI 0.99–1.93, p?=?0.061) and to the ICU (OR 1.89, 95% CI 0.73–4.24, p?=?0.149).

Conclusion

There was no significant independent association between preoperative length of stay and risk of SSI while SSI and postoperative LOS were significantly associated.

     

Fast-track Surgery Improves Postoperative Recovery in Patients with Gastric Cancer: A Randomized Comparison with Conventional Postoperative Care

Background

Fast-track surgery is a new, promising comprehensive program for surgical patients and is beneficial to recovery. Prospective randomized, controlled clinical trials involving fast-track surgery for gastric cancer are lacking.

Patient and methods

Ninety-two patients with gastric cancer were randomly divided into a fast-track surgery group (n?=?45) and conventional surgery group (n?=?47). We compared outcomes (duration of postoperative stay in hospital, fever, and flatus, complications, and medical costs); postoperative serum levels of tumor necrosis factor-α, interleukin-6, and C-reactive protein; and resting energy expenditure between two groups.

Results

Compared with the conventional surgery group, the fast-track surgery group had no more complications (P?>?0.05) with a significantly shorter duration of fever, flatus, and hospital stay, and less medical costs as well as a higher quality of life score on hospital discharge (all P?<?0.05). With a significantly lower resting energy expenditure (days?1 and 3) postoperatively (P?<?0.05), the fast-track surgery group showed a lower serum level of tumor necrosis factor-α (days?1 and 3), interleukin-6 (days?1 and 3), and C-reactive protein (days?1, 3, and 7) than the conventional surgery group (all P?<?0.05).

Conclusions

Fast-track surgery can lessen postoperative stress reactions and accelerate rehabilitation for patients with gastric cancer.     

Additional surgical procedure is a risk factor for surgical site infections after laparoscopic cholecystectomy

Purpose

Surgical site infections (SSI) are associated with increased costs and length of hospital stay, readmission rates, and mortality. The aim of this study was to identify risk factors for SSI in patients undergoing laparoscopic cholecystectomy.

Methods

Analysis of 35,432 laparoscopic cholecystectomies of a prospective multicenter database was performed. Risk factors for SSI were identified among demographic data, preoperative patients’ history, and operative data using multivariate analysis.

Results

SSIs after laparoscopic cholecystectomy were seen in 0.8 % (n?=?291) of the patients. Multivariate analysis identified the following parameters as risk factors for SSI: additional surgical procedure (odds ratio [OR] 4.0, 95 % confidence interval [CI] 2.2–7.5), age over 55 years (OR 2.4 [1.8–3.2]), conversion to open procedure (OR 2.6 [1.9–3.6]), postoperative hematoma (OR 1.9 [1.2–3.1]), duration of operation >60 min (OR 2.5 [1.7–3.6], cystic stump insufficiency (OR 12.5 [4.2–37.2]), gallbladder perforation (OR 6.2 [2.4–16.1]), gallbladder empyema (OR 1.7 [1.1–2.7]), and surgical revision (OR 15.7 [10.4–23.7]. SSIs were associated with a significantly prolonged hospital stay (p?<?0.001), higher postoperative mortality (p?<?0.001), and increased rate of surgical revision (p?<?0.001).

Conclusions

Additional surgical procedure was identified as a strong risk factor for SSI after laparoscopic cholecystectomy. Furthermore, operation time >60 min, age >55 years, conversion to open procedure, cystic stump insufficiency, postoperative hematoma, gallbladder perforation, gallbladder empyema, or surgical revision were identified as specific risk factors for SSI after laparoscopic cholecystectomy.     

How to successfully implement a robotic pediatric surgery program: lessons learned after 96 procedures

Background

Both our teams were the first to implement pediatric robotic surgery in France. The aim of this study was to define the key points we brought to light so other pediatric teams that want to set up a robotic surgery program will benefit.

Methods

We reviewed the medical records of all children who underwent robotic surgery between Nov 2007 and June 2011 in both departments, including patient data, installation and changes, operative time, hospital stay, intraoperative complications, and postoperative outcome. The department’s internal organization, the organization within the hospital complex, and cost were evaluated.

Results

A total of 96 procedures were evaluated. There were 38 girls and 56 boys with average age at surgery of 7.6 years (range, 0.7–18 years) and average weight of 26 kg (range, 6–77 kg). Thirty-six patients had general surgery, 57 patients urologic surgery, and 1 thoracic surgery. Overall average operative time was 189 min (range, 70–550 min), and average hospital stay was 6.4 days (range, 2–24 days). The procedures of 3 patients were converted. Median follow-up was 18 months (range, 0.5–43 months). Robotic surgical procedure had an extra cost of €1934 compared to conventional open surgery.

Conclusions

Our experience was similar to the findings described in the literature for feasibility, security, and patient outcomes; we had an overall operative success rate of 97 %. Three main actors are concerned in the implementation of a robotic pediatric surgery program: surgeons and anesthetists, nurses, and the administration. The surgeon is at the starting point with motivation for minimally invasive surgery without laparoscopic constraints. We found that it was possible to implement a long-lasting robotic surgery program with comparable quality of care.     

Assessing the cost effectiveness of robotics in urological surgery – a systematic review

Study Type – Therapy (systematic review) Level of Evidence 1a What's known on the subject? and What does the study add? Research on the subject has shown that robotic surgery is more costly than both laparoscopic and open approaches due to the initial cost of purchase, annual maintenance and disposable instruments. However, both robotic and laparoscopic approaches have reduced blood loss and hospital stay and robotic procedures have better short term post‐operative outcomes such as continence and sexual function. Some studies indicate that the robotic approach may have a shorter learning curve. However, factors such as reduced learning curve, shorter hospital stay and reduced length of surgery are currently unable to compensate for the excess costs of robotic surgery. This review concludes that robotic surgery should be targeted for cost efficiency in order to fully reap the benefits of this advanced technology. The excess cost of robotic surgery may be compensated by improved training of surgeons and therefore a shorter learning curve; and minimising costs of initial purchase and maintenance. The review finds that only a few studies gave an itemised breakdown of costs for each procedure, making accurate comparison of costs difficult. Furthermore, there is a lack of long term follow up of clinical outcomes, making it difficult to accurately assess long term post‐operative outcomes. A breakdown of costs and studies of long term outcomes are needed to accurately assess the effectiveness of robotic surgery in urology.

OBJECTIVES

• ? Although robotic technology is becoming increasingly popular for urological procedures, barriers to its widespread dissemination include cost and the lack of long term outcomes. This systematic review analyzed studies comparing the use of robotic with laparoscopic and open urological surgery.
• ? These three procedures were assessed for cost efficiency in the form of direct as well as indirect costs that could arise from length of surgery, hospital stay, complications, learning curve and postoperative outcomes.

METHODS

• ? A systematic review was performed searching Medline, Embase and Web of Science databases. Two reviewers identified abstracts using online databases and independently reviewed full length papers suitable for inclusion in the study.

RESULTS

• ? Laparoscopic and robot assisted radical prostatectomy are superior with respect to reduced hospital stay (range 1–1.76 days and 1–5.5 days, respectively) and blood loss (range 482–780 mL and 227–234 mL, respectively) when compared with the open approach (range 2–8 days and 1015 mL). Robot assisted radical prostatectomy remains more expensive (total cost ranging from US $2000–$39 215) than both laparoscopic (range US $740–$29 771) and open radical prostatectomy (range US $1870–$31 518).
• ? This difference is due to the cost of robot purchase, maintenance and instruments. The reduced length of stay in hospital (range 1–1.5 days) and length of surgery (range 102–360 min) are unable to compensate for the excess costs.
• ? Robotic surgery may require a smaller learning curve (20–40 cases) although the evidence is inconclusive.

CONCLUSIONS

• ? Robotic surgery provides similar postoperative outcomes to laparoscopic surgery but a reduced learning curve.
• ? Although costs are currently high, increased competition from manufacturers and wider dissemination of the technology could drive down costs.
• ? Further trials are needed to evaluate long term outcomes in order to evaluate fully the value of all three procedures in urological surgery.

     

Hospital costs associated with surgical morbidity after elective colorectal procedures: a retrospective observational cohort study in 530 patients

Background

Postoperative complications contribute to morbidity and mortality. This study assessed the impact of surgical complications on healthcare resource utilization for patients undergoing elective colorectal procedures.

Method

Data were obtained on 530 consecutive colorectal operations performed from January 2010 to January 2011. Patient demographics, type of procedure, surgical complications classified as Clavien 1–5, length of stay, 60-day readmission rate, and hospital costs were recorded.

Results

Seventy-five percent of the operations were associated with malignancy, and 26% were pelvic procedures. Thirty-five percent of the patients developed at least one complication, 21% of the complications did not require intervention. The readmission rate was 7.4%. Nine patients died during 60-day post discharge follow up.Median length of stay was 9 (3–34) days in uncomplicated and 16 (4–205) days in complicated cases. Occurrence of any complication at index admission increased total hospital costs 2.1-fold (EUR 25,680 vs. EUR 12,405), with the largest cost differential attributed to wound dehiscence and/or suture line failure requiring reoperation. These increases were primarily due to prolonged hospitalization and ICU expenditures. Readmission resulted in a further increase to an average cost of EUR 12,585 per re-admitted patient.Multivariate analysis showed that BMI?>?25, obesity, operation complexity and surgeon significantly affected the risk for complication. Also, hospital costs were significantly increased by any postoperative complications, reoperations, high complexity of surgical procedures and high comorbidity index.

Conclusions

Reducing morbidity after colorectal procedures improves quality of care and patient safety, and may also substantially reduce hospital costs and increase the efficiency of resource utilization.     

Clinical utility of the Revised Cardiac Risk Index in non-cardiac surgery for elderly patients: a prospective cohort study

Purpose

We investigated the association between the Revised Cardiac Risk Index (RCRI) and postoperative outcomes in patients undergoing non-cardiac surgery.

Methods

The predictive value of the RCRI for the risk of perioperative complications, length of hospital stay and hospital cost were evaluated from a prospective cohort of 119 patients aged ≥65 years undergoing elective major digestive, breast or vascular surgery.

Results

Comparing three groups RCRI 0, 1 and ≥2, the morbidity rates were 0, 30 and 68 %; the median length of hospitalization was 5, 14 and 28 days; and the median cost was 665,000, 1,480,000 and 2,160,000 yen, respectively. The mortality rate was 0 % in all groups. The RCRI 0 group included only non-high-risk (breast and peripheral vascular) surgeries. In addition, comparing the two groups by excluding non-high-risk surgeries (RCRI 1 and ≥2), the median morbidity rates were 31 and 67 %, the median length of hospitalization was 15 and 28 days, and the median cost was 1,550,000 and 2,130,000 yen, respectively. The RCRI score was the only independent predictor of the perioperative complications.

Conclusions

In the case of non-cardiac surgery, the RCRI can identify patients at higher risk of perioperative complications, a prolonged hospital stay and higher hospital cost.     

Laparoendoscopic single-site minor hepatectomy for liver tumors

Background

Laparoscopic liver surgery is gaining increasing acceptance worldwide, but its frontiers are constantly challenged. Laparoendoscopic single-site surgery (LESS) has been performed for various organs, but the feasibility of LESS hepatectomies has yet to be explored fully.

Methods

From May 2010 to March 2011, seven patients underwent LESS minor hepatectomies. Patient demographic, operative, and clinical data were reviewed.

Results

Five left lateral sectionectomies, one segment 3, and one segment 5 resection were performed. The median operative time was 142?min (range, 104–171?min), and the median blood loss was 200?ml (range, 100–450?ml). The median hospital stay was 3?days (range, 1–11?days). For all the patients, the indications for surgery were suspected malignant tumors, and the surgical resection margins were clear for every patient.

Conclusions

Laparoendoscopic single-site minor hepatectomy is a novel modification to traditional laparoscopic surgery. The method is safe and feasible without any compromise to oncologic safety for selected patients with hepatocellular carcinoma (HCC) and colorectal liver metastases that are peripheral and smaller than 5?cm in size.     

The effect of annual surgical caseload on the rates of in-hospital pneumonia and other in-hospital outcomes after radical prostatectomy

Purpose

To examine the effect of annual surgical caseload (ASC) on contemporary in-hospital pneumonia (IHP) rates and three other in-hospital outcomes after radical prostatectomy (RP).

Methods

Between 1999 and 2008, 34,490 open RPs were performed in the state of Florida. First, logistic regression models predicting the rate of IHP were fitted. Second, other logistic regression models examined the association between IHP and three other outcomes: in-hospital mortality, hospital charges within the highest quartile, and length of stay (LOS) within the highest quartile. Covariates included ASC, age, race, baseline Charlson Comorbidity Index (CCI), interval between admission and surgery, as well as blood transfusion.

Results

The overall IHP rate was 0.5%. It was higher in patients operated within the low (0.7%) and intermediate (0.5%) ASC tertile versus high ASC tertile (0.2%, P?P?P?P?$37,333, and were 20-fold more likely to have a LOS >3?days (all P?Conclusions RP by high ASC surgeons exerts a protective effect on IHP rates. Additionally, IHP is associated with higher in-hospital mortality, prolonged LOS, and higher hospital charges.     

Subcuticular Absorbable Suture with Subcutaneous Drainage System Prevents Incisional SSI after Hepatectomy for Hepatocellular Carcinoma

Background

The effectiveness of subcuticular absorbable suture with subcutaneous drainage to decrease the risk of postoperative incisional surgical site infection (SSI) in hepatocellular carcinoma (HCC) patients was evaluated.

Methods

A total of 149 patients with HCC who underwent hepatectomy (Hx) were retrospectively investigated. Patients were divided into two groups: the patients with subcuticular suture combined with subcutaneous drainage (the drainage group; 61 patients) and the patients with nylon suture without subcutaneous drainage (the nylon group; 88 patients). After the operations, the complication rate of postoperative incisional SSI was analyzed and compared between the two groups.

Results

In the drainage group the rate of incisional SSI was significantly lower compared to the nylon group: 14–3?% (p?=?0.033), respectively. Patients with incisional SSI needed significantly longer postoperative hospital care than the patients without incisional SSI: 28 versus 15?days (p?p?=?0.034).

Conclusions

We have demonstrated that the subcuticular suture with subcutaneous drainage is effective in preventing incisional SSI in patients undergoing Hx for HCC.     

Delay from fracture to hospital admission: a new risk factor for hip fracture mortality?

Summary

The relationship between surgical timing and hip fracture mortality is unknown in the context of developing countries where large delays to surgery are common. We observed that delay from fracture to hospital admission is associated with decreased survival after a hip fracture.

Introduction

To examine the relationship between the time interval from fracture to surgery as well as its subcomponents (time from fracture to hospital admission and time from admission to surgery) and hip fracture survival.

Methods

The medical records of all patients aged 60?years and older admitted to a public university hospital in the city of Rio de Janeiro with a primary diagnosis of hip fracture between 1995 and 2000 were reviewed. Survival to hospital discharge and at 1?year were examined.

Results

Among 343 patients included in the study, there were 18 (5.3%) in-hospital deaths, and 297 (86.6%) patients remained alive 1?year after surgery. Very long delays from the time of fracture to hospital admission (mean 3?days) and from hospital admission to surgery (mean 13?days) were identified. Increased time from fracture to hospital admission was associated with reduced survival to hospital discharge (hazard ratio [HR] 1.09, 95% CI 1.03–1.15, p?=?0.005) and reduced survival at 1?year after surgery (HR 1.07, 95% CI 1.03–1.10, p?<?0.001). The interval of time from hospital admission to surgery was not associated with reduced survival to hospital discharge (HR 1.03, 95% CI 0.96–1.10, p?=?0.379) or at 1?year after surgery (HR 1.03, 95% CI 0.99–1.07, p?=?0.185).

Conclusions

If the association estimated in our study is causal, our results provide evidence that some hip fracture-related deaths could be prevented by improved patient access to appropriate and timely hospital care in the context of a developing country.     

Impact of preoperative myocardial infarction on surgical outcomes in inpatient orthopaedic surgery

Purpose

The purpose of this study was to evaluate the impact of a preoperative myocardial infarction (MI) on outcomes of inpatient orthopaedic operations.

Methods

The National Surgical Quality Improvement Program database was used to identify patients who underwent common orthopaedic operations from 2006 to 2010. Patient demographic data, comorbidities, complications, and lengths of stay were collected. Multivariate logistic regression and linear regression models were used to compare outcomes for patients with and without a history of MI in the six months prior to surgery.

Results

Of the 32,462 patients identified, 86 had sustained an MI in the six months prior to surgery. The MI cohort had no cardiac complications but had increased incidences of superficial surgical site infection, unplanned re-intubation, ventilator-assisted respiration for more than 48 hours, pneumonia, sepsis or septic shock, and postoperative mortality within 30 days of surgery, as well as prolonged lengths of stay. Following logistic regression to adjust for baseline differences, a history of MI showed no association with cardiac complications and was significantly associated with superficial surgical site infection (OR 3.6, 95 % CI 1.1–11.8), ventilator dependence for over 48 hours (OR 4.0, 95 % CI 1.1–14.0), and extended length of stay (median with interquartile range 4 [4–4] vs. 5 [5–5] days).

Conclusions

A myocardial infarction within six months prior to orthopaedic surgery is not associated with a higher risk of 30-day perioperative cardiac complications; however, it is associated with increased rates of surgical site infection, prolonged ventilator dependence, and longer hospital stay.     

A cost comparison of laparoscopic and open colon surgery in a publicly funded academic institution

Background

The objective of this study was to compare the total hospital cost of laparoscopic (lap) and open colon surgery at a publicly funded academic institution.

Methods

Patients undergoing elective laparoscopic or open colon surgery for all indications at the University Health Network, Toronto, Canada, from April 2004 to March 2009 were included. Patient demographic, operative, and outcome data were reviewed retrospectively. Hospital costs were determined from the Ontario Case Costing Initiative, adjusted for inflation, and compared using the Mann–Whitney U test. Linear regression was used to analyze the relationship between length of stay and total hospital cost.

Results

There were 391 elective colon resections (223 lap/168 open, 15.4 % conversion). There was no difference in median age, gender, or Charlson score. Body mass index was slightly higher for laparoscopic surgery (27.5/25.9 lap/open; p = 0.008), while the American Society of Anesthesiologists score was slightly higher for open surgery. Median operative time was greater for laparoscopic surgery (224/196 min, lap/open; p = 0.001). There was no difference in complication rates (21.6/22.5 % lap/open; p = 0.900), reoperations (5.8/6.5 % lap/open; p = 0.833) or 30-day readmissions (7.6/12.5 % lap/open; p = 0.122). Number of emergency room visits was greater with open surgery (12.6/20.8 % lap/open; p = 0.037). Operative cost was higher for laparoscopic surgery ($4,171.37/3,489.29 lap/open; p = 0.001), while total hospital cost was significantly reduced ($9,600.22/12,721.41 lap/open; p = 0.001). Median length of stay was shorter for laparoscopic surgery (5/7 days lap/open; p = 0.000), and this correlated directly with hospital cost.

Conclusions

Laparoscopic colon surgery is associated with increased operative costs but significantly lower total hospital costs. The cost savings is related, in part, to reduced length of stay with laparoscopic surgery.