Barlas Sulu, MD, Hasan T Kirat, MD, Meagan Costedio, MD, Emre Gorgun, MD, Ravi P Kiran, MD. Cleveland Clinic Foundation
COST-EFFICIENCY OF SINGLE-PORT WHEN COMPARED TO CONVENTIONAL LAPAROSCOPIC COLECTOMY
Background: The aim of this study is to investigate whether single-port laparoscopic colectomy is associated with increased costs when compared with conventional laparoscopic colectomy
Methods: Patients undergoing single-port laparoscopic colectomy between 2007 and 2010 with available cost data (Group SPL) were matched to those with conventional laparoscopic colectomy (Group CL) for age (within 10 years), gender, American Society of Anesthesiologists class, body mass index (within 5 kg/m2), operation type and year (within 3 years). Direct costs for the two groups were compared using appropriate statistical tests.
Results: There were 90 patients in SPL group and 90 patients in CL group. Age (48.7±18.2 vs. 48.1±18.1, p=0.79), gender (male gender, n=46, 51.1% vs. n=45, 50%, p=0.88), body mass index (kg/m2 25.8±5 vs. 25.6±5.2, p=0.82), American Society of Anesthesiologists class (class II, n=66, 73.3% vs. n=66, 73.3%, p=1) and diagnosis (benign, n=71, 78.9% vs. n=72, 80 %, p=0.85) were similar in groups SPL and CL. Type of surgery, estimated blood loss and length of hospital stay were also similar (Table). Operation time was significantly shorter for Group SPL (minutes, 136.1±178.6 vs. 217.9±91.2, p=<0.001), hence anesthesia cost was significantly lower for Group SPL (p=0.003). Total direct costs (p=0.5), operating room (p=0.65), nursing, (p=0.13), pharmacy (p=0.6), radiology (p=0.27), professional (p=0.38) and pathology/laboratory (p=0.46) costs were however similar between groups
Conclusions: Single-port laparoscopic colectomy can be performed with comparative costs to conventional laparoscopic colectomy thus confirming the feasibility and safety of the technique. The additional finding that operating time can be reduced when the single-port technique is adopted by surgeons already facile with the conventional laparoscopic technique, suggests that increasing experience may be associated with reduced costs when compared to conventional laparoscopic colectomy.
| Variable | Group SPL (n=90) | Group CL (n=90) | P value |
| Type of Operation | 1 | ||
| Right hemicolectomy | 26 (28.9%) | 26 (28.9%) | |
| Total abdominal colectomy with EI | 23 (25.6%) | 23 (25.6%) | |
| Sigmoid colectomy | 12 (13.3%) | 12 (13.3%) | |
| Total proctocolectomy with IPAA | 12 (13.3%) | 12 (13.3%) | |
| Ileocecal resection | 10 (11.1%) | 10 (11.1%) | |
| Total abdominal colectomy with IRA | 3 (3.3%) | 3 (3.3%) | |
| Low anterior resection | 2 (2.2%) | 2 (2.2%) | |
| Left hemicolectomy | 2 (2.2%) | 2 (2.2%) | |
| Estimated blood loss, ml | 124.4 ±108.4 | 157.2 ±154.5 | 0.17 |
| Operation time (minutes) | 136.1 ±178.6 | 217.9 ±91.2 | <0.001 |
| Length of hospital stay, days (mean) | 6.5 ±4.7 | 7.6 ±6 | 0.06 |
| EI: End ileostomy, IRA: Ileorectal anastomosis, IPAA: Ileal pouch-anal anastomosis |
Session Number: Poster – Poster Presentations
Program Number: P106
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