Laparoscopic Versus Open Cholecystectomy: A Cost–Effectiveness Analysis at Rwanda Military Hospital

Silverstein, Allison; Costas‐Chavarri, Ainhoa; Gakwaya, Mussa R.; Lule, Joseph; Mukhopadhyay, Swagoto; Meara, John G.; Shrime, Mark G.

doi:10.1007/s00268-016-3851-0

Cited by 26 publications

(29 citation statements)

References 44 publications

(33 reference statements)

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“…(n = 1) [62], India (n = 1) [63], Mexico (n = 1) [64],Rwanda (n = 1) [65], and South Africa (n = 1) [66]. According to the World Bank classifications, the studies were part of the following income groups: Low Income Country (n = 1) [65], Lower Middle Income (n = 2) [62,63] and Upper Middle Income (n = 12) [52-61, 64, 66]. Table 3 shows general characteristics of each study included in the review.…”

Section: Plos Onementioning

confidence: 99%

“…The Center of Disease Control guidelines were used in the majority of the studies to define an SSI [52-57, 61-64, 66]. However, three studies lacked a definition of what constituted a SSI [59,60,65]. One study classified a SSI based on the wound discharge culture or other SSI suggestive signs and symptoms but these were not elaborated further [58].…”

Section: Plos Onementioning

confidence: 99%

“…The lack of followup of patients beyond discharge limited most of the studies to report only inpatient hospital costs. One study had attempted to measure the direct non-medical costs, however the authors did not report it as a cost of an SSI [65]. Most studies did not report the relevant year for the cost estimation (S2 Table).…”

Section: Plos Onementioning

confidence: 99%

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Surgical site infection and costs in low- and middle-income countries: A systematic review of the economic burden

et al. 2020

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Background Surgical site infection (SSI) is a worldwide problem which has morbidity, mortality and financial consequences. The incidence rate of SSI is high in Low-and Middle-Income countries (LMICs) compared to high income countries, and the costly surgical complication can raise the potential risk of financial catastrophe. Objective The aim of the study is to critically appraise studies on the cost of SSI in a range of LMIC studies and compare these estimates with a reference standard of high income European studies who have explored similar SSI costs. Methods A systematic review was undertaken using searches of two electronic databases, EMBASE and MEDLINE In-Process & Other Non-Indexed Citations, up to February 2019. Study characteristics, comparator group, methods and results were extracted by using a standard template. Results Studies from 15 LMIC and 16 European countries were identified and reviewed in full. The additional cost of SSI range

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Section: Plos Onementioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

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Surgical site infection and costs in low- and middle-income countries: A systematic review of the economic burden

et al. 2020

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“…Third, the cost-effectiveness of laparoscopic surgery by utilizing donated equipment could not be evaluated. As shown in a cost-effectiveness analysis of laparoscopic versus open cholecystectomy at Rwanda Military Hospital, laparoscopic surgery may not be cost-effective at commonly accepted willingness-to-pay thresholds with low case volume in LMICs, but laparoscopic surgery can be cost-effective "in settings where machinery has already been donated" [28].…”

Section: Discussionmentioning

confidence: 99%

Establishing a Sustainable Training Program for Laparoscopy in Resource-Limited Settings: Experience in Ghana

Kang

Apea-Kubi

et al. 2020

Annals of Global Health

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Background: Healthcare equipment funded by international partners is often not properly utilized in many developing countries due to low levels of awareness and a lack of expertise. A long-term on-site training program for laparoscopic surgery was established at a regional hospital in Ghana upon request of the Ghana Health Service and local surgeons. Objective: The authors report the initial 32-month experience of implementing laparoscopic surgery focusing on the trainees' response, technical independence, and factors associated with the successful implementation of a "new" surgical practice. Methods: Curricular structure and feedback results of the trainings for doctors and nurses, and characteristics of laparoscopic procedures performed at the Greater Accra Regional Hospital between January 2017 and September 2019 were retrospectively reviewed. Findings: Comprehensive training including two weeks of simulation workshops followed by animal labs were regularly provided for the doctors. Among the 97 trainees, 27.9% had prior exposure in laparoscopic surgery, 95% were satisfied with the program. Eleven nurses attained professional competency over 15 training sessions where none had prior exposure to laparoscopic surgery. Since the first laparoscopic cholecystectomy in February 2017, 82 laparoscopic procedures were performed. The scope of the surgery was expanded from general surgery (n = 46) to gynecology (n = 33), pediatric surgery (n = 2), and urology (n = 1). The volume of local doctors as primary operators increased from 0% (0/17, February to December 2017) to 41.9% (13/31, January to October 2018) and 79.4% (27/34, November 2018 to September 2019), with 72.5% of the cases being assisted by the expatriate surgeon. There were no open conversions, technical complications, or mortalities. Local doctors independently commenced endoscopic surgical procedures including cystoscopies, hysteroscopies, endoscopic neurosurgeries and arthroscopies. Conclusion: Sensitization and motivation of the surgical workforce through long-term continuous on-site training resulted in the successful implementation of laparoscopic surgery with a high level of technical independence.

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“…Financial cost may also be an important factor in driving the selection of surgery type. 44 , 45 To examine cost-effectiveness of the RG and LG, we retrospectively reviewed the overall hospital expenditure and found that the cost of RG group was about 23,000 RMB more than that of the LG group. A recent meta-analysis reported that the RG groups cost about $ 4000 more than the LG groups.…”

Section: Discussionmentioning

confidence: 99%

Robotic versus laparoscopic gastrectomy with D2 lymph node dissection for advanced gastric cancer: a propensity score-matched analysis

et al. 2018

CMAR

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BackgroundRobotic gastrectomy (RG) is a new surgical method alternative for gastric cancer. However, few studies have evaluated the outcomes of RG for advanced gastric cancer (AGC). Thus, the aim of this study was to compare the short-and long-term outcomes of RG and laparoscopic gastrectomy (LG) with D2 lymph node dissection for AGC.Patients and methodsWe retrospectively evaluated 454 patients with AGC who underwent RG or LG with D2 lymph node dissection for AGC between August 2013 and March 2017. The short-and long-term outcomes were compared between the propensity score-matched groups.ResultsThe RG group was associated with longer operation time, less intraoperative blood loss, and higher hospital cost. Additionally, there was a tendency favoring RG in terms of number of harvested lymph nodes, time to first flatus, time to first start diet, and postoperative hospital stay, although the differences were not statistically significant. The overall postoperative complication rate was 13.4% and 11.6% in the RG and LG groups, respectively, with no significant difference (P=0.686). The 3-year overall survival and recurrence rates of the RG and LG groups were also comparable (78.6% vs 74.1%, P=0.483; 18.8% vs 21.4%, P=0.617; respectively).ConclusionRG with D2 lymph node dissection is safe and feasible for AGC in terms of both short- and long-term outcomes. High-volume randomized controlled trials with sufficient follow-up are needed to confirm this rationale.

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Laparoscopic Versus Open Cholecystectomy: A Cost–Effectiveness Analysis at Rwanda Military Hospital

Cited by 26 publications

References 44 publications

Surgical site infection and costs in low- and middle-income countries: A systematic review of the economic burden

Surgical site infection and costs in low- and middle-income countries: A systematic review of the economic burden

Establishing a Sustainable Training Program for Laparoscopy in Resource-Limited Settings: Experience in Ghana

Robotic versus laparoscopic gastrectomy with D2 lymph node dissection for advanced gastric cancer: a propensity score-matched analysis

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