Scott W Rieder, MD, MPH, C M Schlachta, MD, FRCSC. The University of Western Ontario
Objective: To perform a systematic review of economic evaluations comparing laparoscopic versus open colorectal surgery
Background: Laparoscopic colorectal surgery is ever-increasingly being utilized for both benign and malignant processes of the colon. The higher operative cost of MIS surgery is often thought to be offset by other hospital and longtem costs such as earlier discharge. This systematic review seeks to examine the current literature for the cost-effectiveness of laparoscopic colorectal surgery compared to open procedures.
Methods: A systematic review of the literature was conducted using Pubmed, EMBASE and the Cochrane Library of all studies that did an economic analysis of minimally invasive colorectal surgery between 2005 to the present. Studies were included if they included if they included both open and minimally invasive treatment arms, were limited to resections of the colon and rectum, and did quantitative cost-analysis in terms of real dollars. A quality assessment of the papers was conducted using the Consenus on Health Economic Criteria (CHEC) guidelines.
Results: The literature review generated 1514 unique articles and 17 of those papers met the inclusion criteria of our systematic review. Of the studies included, 12 were considered high-quality (CHEC score >= 12). Overall 8 studies found MIS surgery to be cost-saving, 6 favoured open surgery and 3 were cost-neutral. All studies that included metrics for quality life years gained compared to cost (3) found laparoscopic surgery to be a very cost-effective intervention.
Conclusion: From the current literature, the evidence for the costs associated with minimally-invasive surgery versus open colorectal surgery slightly favours the laparoscopic technique. All studies that examined quality outcomes in association with cost found laparscopic colorectal surgery to be very cost-effective. Most studies found the high operative costs of laparoscopic surgery were offset by lesser ward and pharmacologic costs. Further studies should aim to incorporate long-term costs, such as ventral hernias, within their economic outcomes to better elucidate the real cost-savings from laparoscopic surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78012
Program Number: P184
Presentation Session: Poster (Non CME)
Presentation Type: Poster