Safety, Efficacy and Cost-effectiveness of Common Laparoscopic Procedures

Introduction: Although several single-center studies on the outcomes of laparoscopic surgery have shown better surgical outcomes, a large multi-center study on outcomes of common laparoscopic surgical procedures has not been performed. The objective of this study was to retrospectively examine multi-center outcomes of common laparoscopic procedures.

Methods: The University HealthSystem Consortium (UHC) is an alliance of more than 100 academic medical centers and nearly 200 affiliate hospitals. UHC’s Clinical Data Base / Resource Manager (CDB/RM) allows member hospitals to compare patient-level risk-adjusted outcomes for performance improvement purposes. This study is a multi-center, retrospective analysis of the outcomes of common surgical procedures using the UHC database. Three-year discharge data from the UHC database was accessed using International Classification of Diseases (ICD-9) codes for commonly performed surgical procedures between January 2006 and December 2008. Discharge data on six common open (O) and laparoscopic (L) surgical procedures, including cholecystectomy (C), appendectomy (A), reflux surgery (RS), gastric bypass (GB), ventral hernia repair (VHR) and colectomy (CO) was collected. Main outcome measures analyzed were mortality, morbidity, 30-day readmission, intensive care unit (ICU) admission, length of ICU stay, overall length of hospital stay and costs.

Results: A total of 207,984 patients underwent either open or laparoscopic surgery for one of the six surgical procedures included in the study. Lower mortality index, reduced length of stay and reduced costs were observed with laparoscopic procedures compared to open procedures. Patients in the laparoscopic group had lower mortality index (0.82 for LC vs. 1.01 for OC; 0.82 for LA vs. 0.85 for OA; 0.23 for LRS vs. 0.72 for ORS; 0.68 for LGB vs. 0.95 for OGB; 0.00 for LVHR vs. 0.89 for OVHR; 0.61 for LCO vs. 1.16 for OCO). Laparoscopic group showed significantly reduced length of stay (in days) for all six procedures (3.89 for LC vs. 10.11 for OC; 2.26 for LA vs. 4.26 for OA; 2.94 for LRS vs. 7.38 for ORS; 2.62 for LGB vs. 5.95 for OGB; 3.71 for LVHR vs. 7.89 for OVHR; 7.13 for LCO vs. 13.12 for OCO; p<0.001). Hospital costs for all six surgical procedures were significantly less for the laparoscopic group. On stratification by severity of illness, patients with major/extreme illness showed a tendency toward open procedure. However, regardless of severity of illness, the laparoscopic group showed relatively better surgical outcomes than patients in the open group.

Conclusions: This retrospective, multi-center analysis of common surgical procedures demonstrated that laparoscopic surgery outcomes are superior to open surgery outcomes. In the major/extreme severity of illness group, open surgery is still more common but the outcomes of laparoscopic surgery tend to be better. Laparoscopic surgery is safe, efficacious and cost-effective for these common surgical procedures and should be the procedure of choice regardless of severity of illness.

Session: Podium Presentation

Program Number: S046

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