Is pediatric laparoscopic splenectomy safe and cost-effective?

OBJECTIVE

To determine whether laparoscopic splenectomy (LS) is a safe, cost-effective alternative to open splenectomy (OS).

DESIGN

Retrospective comparison and economic evaluation.

SETTING

Tertiary care children's hospital.

PATIENTS

Children with hematologic disease involving the spleen.

INTERVENTIONS

Laparoscopic splenectomy (10 patients); OS (10 patients).

MAIN OUTCOME MEASURES

Safety of LS and cost differential between LS and OS.

RESULTS

Operative time was longer for LS. Discharge occurred 64 hours postoperatively for LS and 79 hours for OS (P < .03). Patients who underwent LS returned to activity 1 to 5 weeks faster than patients who underwent OS. The average (+/-SD) operative charges for LS was $7176 +/- $2064 and for OS, $1977 +/- $344 (P < .001). Total hospital charges averaged $13,033 +/- $2976 for LS and $7106 +/- $1923 for OS (P < .001).

CONCLUSIONS

Laparoscopic splenectomy can be performed safely in children. In our hospital, LS is more expensive than OS. The faster return to school and normal activity warrants the continued use of this procedure despite the increased cost.