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BACKGROUND:
Single-site laparoscopy provides an alternative minimally invasive approach to standard laparoscopy. There is currently no published data comparing costs for patients and hospitals accrued by these two techniques for colorectal surgery. We provide cost comparisons between single-site and standard laparoscopic colorectal surgeries performed at a single institution.
METHODS:
An IRB approved, retrospective review of all standard (SDL) and single-site laparoscopic (SSL) colon and rectal resections performed from 2008-2011 was undertaken. Two-sided Mann-Whitney U tests and two-sided Fisher’s exact tests were used to evaluate continuous and discrete variables, respectively, comparing total hospital charges to patients, costs to the hospital and hospital payments received. Charges to patients were further subcategorized by charges accrued from the operating room, from room and board, pharmacy, radiology and emergency department visits. All monetary units were inflation adjusted to represent 2011 US dollar value.
RESULTS:
A total of 167 SDL and 47 SSL cases were identified. Compared to SSL, SDL surgeries were associated with longer median times in the operating room (SSL: 190 min vs. SDL: 233 min; p=0.01) as well as longer median times for completion of surgery (SSL: 128 min vs. SDL:183 min, p=0.009). Despite these differences, median operating room costs were similar (SSL: \,110 vs. SDL: \,460; p=0.36). Median postoperative length of hospital stay was similar for SSL (3.5 days) and SDL (4 day; p=0.87), with no significant differences with respect to patient room charges (SSL: \,080 vs. SDL: \,940; p=0.59). There was no significant difference between SSL and SDL with respect to total patient charges (SSL: \,700 vs. SDL: \,100; p=0.06), costs to the hospital (SSL: \,100 vs. SDL: \,300; p=0.48) and actual hospital payments received (SSL: \,100 vs. SDL: \,200; p=0.9). There were no significant differences between the two groups with respect to radiology, pharmacy or emergency department charges. Among laparoscopic cases requiring conversion to laparotomy, SSL and SDL had similar median operating room costs (SSL: \,990 vs. SDL: \,560; p=0.32), though SSL was found to have approximately two-fold higher median overall patient charges (SSL: \,497 vs. SDL: \,392; p=0.006) and costs to the hospital (SSL: \,837 vs. SDL: \,111; p=0.01) compared to SDL.
CONCLUSION:
Adopting a single-site laparoscopic approach for colon and rectal surgery provides for similar lengths of hospital stay and similar costs to patients and hospitals compared to standard laparoscopic surgery. Conversion from SSL to open surgery is more costly to hospitals and patients than are conversions from SDL to open surgery, which may suggest that patients at high risk for requiring conversion to laparotomy should not be offered SSL.