FROM THE ANNALS OF SURGERY
Laparoscopic colectomy is less expensive than open colectomy only when it is performed by surgeons experienced with the laparoscopic approach, according to a study published in the Annals of Surgery.
Many studies have demonstrated that compared with the open surgery, the laparoscopic approach reduces the cost of major abdominal operations including colectomy by as much as 50%. These savings are attributed to the shorter length of stay and lower complication rate associated with laparoscopic surgery.
These findings seem to suggest that laparoscopic surgery is always less expensive than open surgery, though very few studies have directly addressed cost, said Kyle H. Sheetz, MD, of the department of surgery, University of Michigan and the Center for Healthcare Outcomes and Policy, both in Ann Arbor, and his associates.
“The present study underscores and clarifies the complex relationship between surgeon experience, postoperative complications, and healthcare payments. It builds on prior analyses of surgical cohorts that demonstrate an association of higher complication rates with significantly increased total episode payments,” the investigators wrote.
To assess payments for laparoscopic vs. open colectomy, they performed a population-based analysis of information in a national Medicare database regarding 182,852 procedures done in 2010-2012. They included payments for complications, readmissions, and postacute care as well as for the surgery and hospital stay.
To examine any possible effects of the surgeons’ experience on the resulting costs, the data were divided into quartiles of experience with laparoscopy. The investigators then compared surgeons with the least experience (the lowest quartile), the most experience (the highest quartile), and intermediate experience (the two middle quartiles).
Among the surgeons with the least experience in laparoscopy, Medicare payments were actually higher for laparoscopic ($26,915) than for open colectomy ($23,312). In contrast, among surgeons with the most experience, payments were substantially lower for laparoscopic ($20,476) than for open colectomy ($23,793).
This difference was attributed to the less experienced surgeons’ higher complication rates; higher readmission rates; and greater need for postacute care services, such as discharging the patient to a skilled nursing facility rather than home, the investigators said (Ann Surg. 2017 May 25. doi: 10.1097/SLA.0000000000002312 ).
These findings demonstrate that “the financial benefits of laparoscopy are only realized when the surgeon has appropriate experience or proficiency.” They have important implications, highlighting the need for more rigorous credentialing standards for individual surgeons and for improving continuing medical education through more extensive proctoring or coaching to enhance surgical skills, Dr. Sheetz and his associates said.
The study results also “make a business case for investing in the training and retraining of surgeons in practice,” they added
“New procedures are continually introduced into practice, and surgeons need to take the time to learn them safely. Taking time to learn new procedures is expensive. Increasing the number of surgeons at a given hospital who are, however, proficient with complex laparoscopy has an important beneficial impact on the financial bottom line for hospitals and health care payers,” the investigators noted.
This study was supported by The National Institutes of Health. Dr. Sheetz and his associates reported having no relevant financial disclosures.
