Comparison of health-care utilization and expenditures for minimally invasive vs. open colectomy for benign disease

Abstract

Background Adoption of minimally invasive approaches continues to increase, and there is a need to reassess outcomes and cost. We aimed to compare open versus minimally invasive colectomy short- and long-term health-care utilization and payer/patient expenditures for benign disease. Methods This is a retrospective analysis of IBM® MarketScan® Database patients who underwent left or right colectomy for benign disease between 2013 and 2018. Outcomes included total health-care expenditures, resource utilization, and direct workdays lost up to 365 days following colectomy. The open surgical approach (OS) was compared to minimally invasive colectomy (MIS) with subgroup analysis of laparoscopic (LS) and robotic (RS) approaches using inverse probability of treatment weighting. Results Of 10,439 patients, 2531 (24.3%) had open, 6826 (65.4%) had laparoscopic, and 1082 (10.3%) had robotic colectomy. MIS patients had shorter length of stay (LOS; mean difference, − 1.71, p < 0.001) and lower average total expenditures (mean difference, − $2378, p < 0.001) compared with open patients during the index hospitalization. At 1 year, MIS patients had lower readmission rates, and fewer mean emergency and outpatient department visits than open patients, translating into additional savings of $5759 and 2.22 fewer days missed from work for health-care visits over the 365-day post-discharge period. Within MIS, RS patients had shorter LOS (mean difference, − 0.60, p < 0.001) and lower conversion-to-open rates (odds ratio, 0.31 p < 0.001) during the index hospitalization, and lower hospital outpatient visits (mean difference, − 0.31, p = 0.001) at 365 days than LS. Conclusion MIS colectomy is associated with lower mean health-care expenditures and less resource utilization compared to the open approach for benign disease at index operation and 365-days post-discharge. Health-care expenditures for LS and RS are similar but shorter mean LOS and lower conversion-to-open surgery rates were observed at index operation for the RS approach.

Health-care expenditures are less for minimally invasive than open colectomy for colon cancer: A US commercial claims database analysis

“…As has been demonstrated by other investigators, the MIS group demonstrated a lower perioperative complication rate compared to OS [ 6 , 10 , 15 ]. Health-care expenditure at 30-day post-discharge is shown in Supplementary Table 4.…”

“…To minimize the effect of potential confounding factors without reducing the sample size, we performed inverse probability of treatment weighting (IPTW) with stabilized weights [ 12 ]. Propensity score weights were calculated from logistic regression models with all the baseline patient factors mentioned above except for DRG as covariates based on prior knowledge and literature [ 10 , 13 , 14 ]. After IPTW, covariates were considered balanced if the absolute value of the standardized mean difference (SMD) was less than 0.1.…”

“…Health-care environment financial pressures have led some to question the value of minimally approaches due to higher intraoperative costs. We previously showed that surgical health-care expenditures were significantly less for the MIS than the open approach for benign colon diseases [ 10 ]. Malignant diagnoses were excluded in that study to limit the confounding effect of expenses such as systemic chemotherapy or variable presentations that were unique to colon cancer.…”

Robotic versus laparoscopic left colectomy: a systematic review and meta-analysis

“…1) after excluding duplicates. Twenty-one studies were excluded [18][19][20][21][22][23][24][25][26][27][28][36][37][38][39][40][41][42][43][44][45][46]. The reasons for exclusion were cohort with less than 20 RLC cases [25,[41][42][43][44][45][46], impossibility to extract data on RLC [18][19][20][21][22][23][24][36][37][38][39][40] or data overlap [26][27][28].…”

“…Twenty-one studies were excluded [18][19][20][21][22][23][24][25][26][27][28][36][37][38][39][40][41][42][43][44][45][46]. The reasons for exclusion were cohort with less than 20 RLC cases [25,[41][42][43][44][45][46], impossibility to extract data on RLC [18][19][20][21][22][23][24][36][37][38][39][40] or data overlap [26][27][28]. Eleven studies published between 2013 and 2022 were considered eligible for data extraction and were therefore included in the meta-analysis [6][7][8][9][10]…”