• Johannes A Govaert, Marta Fiocco, Wouter A van Dijk, Nikki E Kolfschoten, Hubert A Prins, Dekker Jan-Willem T JWT, Tollenaar Rob A E M RAEM, Pieter J Tanis, Wouters Michel W J M MWJM, and Dutch Value Based Healthcare Study Group.
• *Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands †Department of Surgery, Groene Hart Ziekenhuis, Gouda, The Netherlands ‡Department of Medical Statistics and Bioinformatics, Leiden University Mathematical Institute, Leiden University Medical Center, Leiden, The Netherlands §Performation, Bilthoven, The Netherlands ¶X-IS, Delft, The Netherlands ||Department of Surgery, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands **Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands ††Department of Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands ‡‡Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
• Ann. Surg. 2017 Dec 1; 266 (6): 1021-1028.

ObjectiveTo compare actual 90-day hospital costs between elective open and laparoscopic colon and rectal cancer resection in a daily practice multicenter setting stratified for operative risk.BackgroundLaparoscopic resection has developed as a commonly accepted surgical procedure for colorectal cancer. There are conflicting data on the influence of laparoscopy on hospital costs, without separate analyses based on operative risk.MethodsRetrospective analyses using a population-based database (Dutch Surgical Colorectal Audit). All elective resections for a T1-3N0-2M0 stage colorectal cancer were included between 2010 and 2012 in 29 Dutch hospitals. Operative risk was stratified for age (<75 years or ≥75 years) and ASA status (I-II/III-IV). Ninety-day hospital costs were measured uniformly in all hospitals based on time-driven activity-based costing.ResultsTotal 90-day hospital costs ranged from &OV0556;10474 to &OV0556;20865 in the predefined subgroups. For colon cancer surgery (N = 4202), laparoscopic resection was significant less expensive than open resection in all subgroups, savings because of laparoscopy ranged from &OV0556;409 (<75 years ASA I-II) to &OV0556;1932 (≥75 years ASA I-II). In patients ≥75 years and ASA I-II, laparoscopic resection was associated with 46% less mortality (P = 0.05), 41% less severe complications (P < 0.001), 25% less hospital stay (P = 0.013), and 65% less ICU stay (P < 0.001). For rectal cancer surgery (N=2328), all laparoscopic subgroups had significantly higher total hospital costs, ranging from &OV0556;501 (<75 years ASA I-II) to &OV0556;2515 (≥75 years ASA III-IV).ConclusionsLaparoscopic resection resulted in the largest cost reduction in patients over 75 years with ASA I-II undergoing colonic resection, and the largest cost increase in patients over 75 years with ASA III-IV undergoing rectal resection as compared with an open approach.

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