Utilization of Laparoscopic Colon Surgery in the Texas Inpatient Public Use Data File (PUDF)

Abstract

Background: Laparoscopic surgery has become the standard of care for the most common surgical procedures performed. However, laparoscopic techniques have not reached this same penetrance in colorectal surgery. We wanted to determine the percentage of colon operations performed in Texas that were done via laparoscopic, robotic and open techniques. Methods: The Texas Inpatient Public Use Data File (PUDF) was queried using ICD-9-CM diagnostic and procedure codes to determine overall utilization of laparoscopic colectomies (LC) in Texas between 2013-14 for reporting facilities. We specifically looked at cost and the length of stay for LC, open colectomy (OC) and robotic assisted colectomy (RAC). Results: In the state of Texas between 2013-14 there were 20,454 colectomies performed. Of these 12,328 (60.3%) were OC, 7,536 (36.8%) were LC, and 590 (3.9%) were RAC. Average total cost was $117,113 for OC, $75,741.9 for LC, and $81,996.2 for RAC. Average length of stay for each technique was 10.6 days for OC, 6.1 days for LC, and 5.1 days for RAC. The risk of a postoperative complication occurring was higher in the open procedure than a laparoscopic procedure. Conclusions: LC accounted for only 36.8% of all colectomies performed in Texas between 2013-14. OC costs twice as much as LC and increased the length of stay by nearly 4 d. LC and RAC are both associated with significantly less cost and length of stay for patients undergoing surgery, while lowering perioperative complications. Disclosures: None of the authors have any relevant disclosures.

All-cause 30- and 90-day inpatient readmission costs associated with 4 minimally invasive colon surgery approaches: A propensity-matched analysis using Medicare and commercial claims data

“…Several studies have shown that robotic-assisted colon surgery is associated with a significantly higher cost of care compared to conventional laparoscopy [ [42] , [43] , [44] , [45] , [46] ], predominantly due to its longer procedure times [ 44 , 45 ]. A propensity score–matched analysis using a nationwide hospital record database including 531,536 patients undergoing surgical treatment for colon cancer determined that robotic-assisted surgery was associated with a 13.6% higher cost than laparoscopic surgery ( P < .0001) [ 42 ].…”

“…These figures do not factor in the $1.55 million investment for the robot and its annual service contract ranging from $80,000 to $190,000 [ 47 , 48 ]. Adoption of robotic-assisted surgery is trending higher than conventional laparoscopic surgery despite its higher cost and comparable outcomes to conventional laparoscopic surgery [ [42] , [43] , [44] , [45] , [46] , 49 ].…”

“…Colon surgery is a common procedure with a high rate of postoperative adverse events that are expected to substantially contribute to hospital costs [ 9 ]. Studies comparing conventional laparoscopic and robotic-assisted minimally invasive colon surgery show that both techniques are safe, feasible, and demonstrate comparable outcomes, but that robotic-assisted surgery significantly increases costs [ [42] , [43] , [44] , [45] , [46] ]. To our knowledge, there are currently no studies that assess which minimally invasive colon surgery approach may be associated with the least 30- and 90-day downstream complication and inpatient hospital readmission rates and costs.…”

Robotic ambulatory colorectal resections: a systematic review

“…With regards to colorectal resections, robotic techniques have been practiced since 2001 and has even been proven to be as effective and safe as its laparoscopic counterpart. Based on the current research, robotic surgery further shortens the length of hospital stay compared to laparoscopic surgery [ 16 – 18 ].…”

Healthcare reform: let science, not politics, lead the way

“…For instance, coronary artery bypass grafting costs $76,384 in the United States, $17,667 in Germany, and a mere $7,323 in Korea. In the United States, the average cost of a colectomy is approximately $75,741, while in Korea, the average cost is $5,325, inclusive of government reimbursements [6,7]. Additionally, hospitals incur separate instrumental costs, which are not covered under the reimbursement In short, providing essential medical care, leads to financial losses for hospitals.…”