• Michael H Gerber, Daniel Delitto, Cristina J Crippen, Thomas J George, Kevin E Behrns, Jose G Trevino, Jessica L Cioffi, and Steven J Hughes.
• Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Rd, Room 6165, PO Box 100109, Gainesville, FL, 32610, USA.
• J. Gastrointest. Surg. 2017 Sep 1; 21 (9): 1404-1410.

ObjectiveWe sought to determine if laparoscopic pancreatoduodenectomy (LPD) is a cost-effective alternative to open pancreatoduodenectomy (OPD).MethodsHospital cost data, discharge disposition, readmission rates, and readmission costs from periampullary cancer patient cohorts of LPD and OPD were compared. The surgical cohorts over a 40-month period were clinically similar, consisting of 52 and 50 patients in the LPD and OPD groups, respectively.ResultsThe total operating room costs were higher in the LPD group as compared to the OPD group (median US$12,290 vs US$11,299; P = 0.05) due to increased costs for laparoscopic equipment and regional nerve blocks (P ≤ 0.0001). Although hospital length of stay was shorter in the LPD group (median 7 vs 8 days; P = 0.025), the average hospital cost was not significantly decreased compared to the OPD group (median $28,496 vs $28,623). Surgery-related readmission rates and associated costs did not differ between groups. Compared to OPD patients, significantly more LPD patients were discharged directly home rather than to other healthcare facilities (88% vs 72%; P = 0.047).ConclusionFor the index hospitalization, the cost of LPD is equivalent to OPD. Total episode-of-care costs may favor LPD via reduced post-hospital needs for skilled nursing and rehabilitation.

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