TY - JOUR
T1 - Economics and the laparoscopic surgery learning curve
T2 - Comparison with open surgery for rectosigmoid cancer
AU - Park, Jun Seok
AU - Kang, Sung Bum
AU - Kim, Sung Wook
AU - Cheon, Gui Neum
PY - 2007/9
Y1 - 2007/9
N2 - Background: Wide-ranging costs of laparoscopic surgery (LAP) are associated with variations in the experience levels of surgeons. There is no available report on the changes of economic outcomes relative to the LAP learning curve in the treatment of colorectal cancer. In the present study, we have compared changes in economic outcomes according to the LAP learning curve with the economic outcomes of open surgery (OS) for rectosigmoid cancer. Methods: A total of 197 patients with rectosigmoid cancer were included in this analysis; 116 received LAP and 81 received OS. Scatter of operative times demonstrated an early learning period of 37 cases in LAP. The following outcomes were compared between LAP and OS during the early learning period and experienced periods; operating room (OR) costs, OR-related hospital profit, total hospital charge, and patient payment. During the median interval of two periods according to the laparoscopic surgery learning curve, there was an inflation rate of about 10% on the medical charges such as operation, radiology, laboratory, and admission fee. Results: Operating room costs were significantly higher after LAP during the two periods, but the median difference between LAP and OS decreased during the experienced period ($3,055 to $1,850). With increasing operative experience in LAP, the OR-related hospital deficit improved (-$1,072 to-$840). Total hospital charges were significantly higher for LAP than for OS in the early learning period (p < 0.05), but they were similar in the experienced period ($7,983/patient versus $7,045/patient, p > 0.05). During the experienced period, patients paid a lower surcharge for LAP ($1,885-$1,118). Conclusions: Total hospital charges for laparoscopic surgery were substantially higher than those of open surgery during the early learning period, but become similar during the experienced period. The shortening of the learning period is a critical factor for achieving cost-effective laparoscopic surgery.
AB - Background: Wide-ranging costs of laparoscopic surgery (LAP) are associated with variations in the experience levels of surgeons. There is no available report on the changes of economic outcomes relative to the LAP learning curve in the treatment of colorectal cancer. In the present study, we have compared changes in economic outcomes according to the LAP learning curve with the economic outcomes of open surgery (OS) for rectosigmoid cancer. Methods: A total of 197 patients with rectosigmoid cancer were included in this analysis; 116 received LAP and 81 received OS. Scatter of operative times demonstrated an early learning period of 37 cases in LAP. The following outcomes were compared between LAP and OS during the early learning period and experienced periods; operating room (OR) costs, OR-related hospital profit, total hospital charge, and patient payment. During the median interval of two periods according to the laparoscopic surgery learning curve, there was an inflation rate of about 10% on the medical charges such as operation, radiology, laboratory, and admission fee. Results: Operating room costs were significantly higher after LAP during the two periods, but the median difference between LAP and OS decreased during the experienced period ($3,055 to $1,850). With increasing operative experience in LAP, the OR-related hospital deficit improved (-$1,072 to-$840). Total hospital charges were significantly higher for LAP than for OS in the early learning period (p < 0.05), but they were similar in the experienced period ($7,983/patient versus $7,045/patient, p > 0.05). During the experienced period, patients paid a lower surcharge for LAP ($1,885-$1,118). Conclusions: Total hospital charges for laparoscopic surgery were substantially higher than those of open surgery during the early learning period, but become similar during the experienced period. The shortening of the learning period is a critical factor for achieving cost-effective laparoscopic surgery.
UR - http://www.scopus.com/inward/record.url?scp=34548048101&partnerID=8YFLogxK
U2 - 10.1007/s00268-007-9154-8
DO - 10.1007/s00268-007-9154-8
M3 - Article
C2 - 17623232
AN - SCOPUS:34548048101
SN - 0364-2313
VL - 31
SP - 1827
EP - 1834
JO - World Journal of Surgery
JF - World Journal of Surgery
IS - 9
ER -
