Cost implications and oncological outcomes for laparoscopic versus open surgery for right hemicolectomy.

INTRODUCTION

Recent studies have suggested that laparoscopic surgery for colorectal resection confers a cost benefit compared with open surgery. These studies have considered a wide range of colorectal operations together rather than focusing on a single procedure. Our study compared direct clinical costs for laparoscopic versus open right hemicolectomy.

METHODS

Clinicopathological data and cost of treatment for all patients who underwent a right hemicolectomy between 2012 and 2013 were collected. The primary outcome was total cost of treatment. Secondary outcomes were length of stay, operative time and morbidity. The minimum follow-up duration was 12 months. Costs for laparoscopic and open surgery for elective resection alone were compared. Further analyses were performed comparing emergency cases with elective cases and cancer with non-cancer cases.

RESULTS

There were 83 patients who underwent a right hemicolectomy during the study period and of these, 65 had an elective procedure. The total cost of a laparoscopic procedure was £3,998.12 compared with £3,427.50 for open surgery (p=0.039). The length of stay was shorter for laparoscopic surgery while the cost of an emergency right hemicolectomy was significantly greater than for elective surgery.

CONCLUSIONS

Although the length of stay for laparoscopic surgery was shorter, this did not translate to a reduction in cost. The cost benefit from a shorter length of stay was offset by a greater cost of consumables. Cost effectiveness analyses should be designed carefully, and they should consider individual operations separately when making healthcare management and funding decisions.