Benjamin Clapp, MD, Evan Liggett, MD, William Klingsporn, MD, Ira L Swinney, MS, Mallory Schenk, BS, Alan Tyroch, MD, Brian Davis, MD, Christopher Dodoo, MS. Texas Tech HSC Paul Foster School of Medicine
Introduction: Laparoscopic surgery has become the standard of care for the most common surgical procedures performed. However, laparoscopic techniques have not reached this same penetrance in colorectal surgery. We set out to determine the percentage laparoscopic colon (LC) surgeries constituted in Texas by querying an administrative claims based database. The secondary outcome that we studied was the cost of LC verus open and robotic techniques.
Methods: The Texas Inpatient Public Use Data File (PUDF) was queried using ICD-9-CM diagnostic and procedure codes to determine overall utilization of LC in Texas between 2013-14 for reporting facilities. We specifically looked at cost, length of stay, and complications of LC, open colectomy (OC) and robotic assisted colectomy (RAC). Quantitative variables were summarized using mean and standard deviation (SD). Categorical variables were described using frequencies and proportions. Differences in postoperative complications were assessed and reported using the generalized linear model and further reported as prevalence ratio (PR) with their 95% confidence interval (CI). Further, a cost analyses were carried out using a linear regression model on reported total charges. This was reported using the regression coefficients (RC) and CI. All analyses were carried out using STATA 15.
Results: In the state of Texas between 2013-14 there were 20,454 colectomies performed. Of these 12,328 (60.3%) were OC, 7,536 (36.8%) were LC, and 590 (3.9%) were RAC. Average total cost per procedure was $117,113 for OC, $75,741 for LC, and $81,996 for RAC. Average length of stay for each technique was 10.6 days for OC, 6.1 days for LC, and 5.1 days for RAC. White, non-Hispanic patients were more likely to undergo LC (PR 1.14 and 1.16). The risk of a post-operative complication occurring was higher in the open procedure than a laparoscopic procedure.
Conclusions: LC accounted for 36.8% of all colectomies performed in Texas between 2013-14. OC had twice the cost as LC and increased the length of stay by nearly 4 days. LC significantly decreased the cost and length of stay for patients undergoing surgery while not significantly increasing perioperative complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92361
Program Number: P344
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster