Marc G Mesleh, MD, John A Stauffer, MD, Steven P Bowers, MD, Horacio J Asbun, MD
Mayo Clinic Florida
Introduction
The laparoscopic approach to pancreaticoduodenectomy has progressed in technique and efficiency, and its utilization is increasing. While laparoscopic pancreaticoduodenectomy (LPD) has been shown to be safe and feasible, comparing its cost in relation to open pancreaticoduodenectomy (OPD) has not been examined. The aim of this study is to examine the cost of LPD compared to OPD at a single institution over a three year time period.
Methods
An institutional database was analyzed to compare patients who underwent OPD and LPD (including Whipple resections and total pancreatectomy) between May 2009 and June 2012. A cost analysis was performed which included the use the hospital billing database to assess operating room (OR) costs, hospital admission costs, and overall cost of the patient’s care during the index admission. The operative costs were further analyzed with respect to OR time and OR supplies. Standard statistical analysis was performed to assess for significance.
Results
In the study time period, 123 patients underwent pancreaticoduodenectomy, including 48 OPD (39%) and 75 LPD (61%). The groups were similar with respect to age, gender, ASA, vein resection, and indication for surgery. Included in the LPD group, there were 3 cases which used hand assist (4%) and 10 cases which converted to open (13%). Additionally, 10% of the OPD group underwent total pancreatectomy (n=5), compared to 21% of the LPD (n=16). Median hospital stay for OPD and LPD was 8 days (range: 5-63), and 7 days (range: 4-68) respectively (p=0.5).
The LPD group was associated with significantly higher OR cost due to both increased time and supply cost. However, mean hospital admission cost associated with OPD was greater in comparison to the LPD group, though not significant. The overall total cost of care was similar between the two groups.
Analysis of the subgroup of cases that were converted from laparoscopic to open revealed the mean OR cost was similar at $18,461. However, the mean associated hospital cost was $69,328, and therefore the mean overall cost was significantly increased at $87,790 (p=0.001).
Conclusion
LPD is associated with equivalent overall cost when compared to OPD. While operating time and supply costs were higher for LPD, this was balanced by decreased cost of the postoperative admission. Patients undergoing LPD with conversion to open were noted to have the highest overall costs of both groups.
Open (n=48) | Laparoscopic (n=75) | p-value | |
| OR Cost | $12,061 ± $3525 | $16,401 ± $3217 | <0.0001 |
| OR Time Cost | $8208 ± $2392 | $10,774 ± $2464 | <0.0001 |
| OR Supply Cost | $3762 ± 2079 | $5396 ± $1695 | <0.0001 |
| Admission Cost | $32,768 ± $37,265 | $28,972 ± $42,017 | 0.61 |
| Total Cost | $44,829 ± 39,365 | $45,372 ± $44,095 | 0.95 |
Session: Podium Presentation
Program Number: S114