Does the Learning Curve During Laparoscopic Colectomy Adversely Affect Costs?

Background: The aim of this study is to investigate whether the learning curve during laparoscopic colectomy (LC) is associated with increased costs when compared with the procedure after the learning curve has been achieved.
Methods: Direct costs for patients undergoing LC during the learning curve (Group A) and after the attainment of proficiency by two colorectal surgeons performing the procedure (Group B) between 2001 and 2007 were compared. Learning curve was defined as the first 40 LC cases for each surgeon. Distribution of cases for the surgeons ensured that costs differences were not influenced by lead time bias of cases performed during the learning curve.
Results: There were 80 Grp A and 74 Grp B patients. Age (57.6 ±15.5 vs.58 ±15.8 yrs, p=0.72), gender (female, n=42, 52.5% vs. n=35, 47.3%, p=0.52), ASA score (p=0.76), body mass index (27.2 ±4.96 vs. 28.4±6.3, p=0.3), diagnosis (p=0.88), previous abdominal surgery (n=19, 48.7% vs. n=10, 27.8%, p=0.07) and comorbidity (p= 0.44) were similar for groups A and B. Performance of anastomosis or resection (p= 0.17, p=0.58, respectively), conversion to open surgery (n=17, 21.2% vs. n=18, 24.3%, p=0.65), postoperative morbidity (p=0.73), readmission (n=6, 7.5% vs. n=12, 16.2%, p=0.1), and reoperation rate (n=1, 1.2% vs. n=2, 2.7%, p=0.61) were similar. Operation time was significantly longer for group A (Group A, 172.84 ± 62.86 vs. Group B, 146.27 ± 39.22, p=0.013). Total direct costs (p=0.7) and operating room (p= 0.58), nursing (p= 0.72), pharmacy (p=0.95), radiology (p=0.98), and professional (p=0.051) costs were however similar between groups.
Conclusions: As expected, the learning curve period during LC is associated with prolonged operating time. Concerns pertaining to increased conversions, complications or direct costs during this period are not substantiated.


Session: Poster

Program Number: P151

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