L. Tedesco1, J. Paolino1, L. Chen1, J. Yoo1, M. Kiely1 1Tufts Medical Center,Boston, MA, USA
Introduction: Endoscopic removal of benign colon polyps is not always possible, even with advanced endoscopic techniques. While segmental colectomy has been the traditional therapy for these polyps, this procedure is associated with an increased risk of complications and may be unnecessary given that fewer than 20% of these polyps harbor malignancy. Combined endoscopic laparoscopic surgery (CELS) has emerged as an alternative method to address these polyps. Here, endoscopic removal of complex polyps is facilitated by laparoscopic manipulation of the bowel wall, thereby avoiding a bowel resection and its associated risks. While feasibility, safety, and improved short term patient outcomes have been demonstrated, there has never been an evaluation of cost comparing these two approaches within a single institution.
Methods: In this observational cohort study, we examined five patients who underwent CELS for right colon polyps at a large tertiary care center (Tufts Medical Center, TMC) between April 2014 and July 2015. We compared the cost of CELS to that of ten patients who underwent a traditional laparoscopic right colectomy performed for a colon polyp or cancer during the study period. The cost analysis covered the perioperative period from operating room to hospital discharge. Microcosting estimates were obtained from the literature and applied to our specific operating room time and length of stay data for our cohorts. A modified societal perspective was used as the costing structure, with all cost estimates obtained for university hospital settings. The costing estimates were adjusted using the medical consumer price index to 2014 US dollars.
Results:A total of five patients were taken to the operating room with the intention of performing CELS for right colon polyps. Four out of the five patients successfully underwent CELS surgery. The median length of stay (LOS) for all successful CELS patients was 1 day. LOS for patients who underwent a laparoscopic right colectomy at TMC over the same time period was 4.5 days. The median OR time for successful CELS was 157.5 minutes, compared to 141.5 minutes for a laparoscopic right colectomy. The calculated total cost for a CELS patient was $7,513.10, compared to $14,600.50 for a laparoscopic right colectomy, a 49% cost-savings almost entirely attributable to a difference in length of stay.
Conclusion:In the perioperative period, successful CELS procedures are performed at a lower cost compared to traditional laparoscopic colectomy, with the most significant cost saver being shorter hospital length of stay. This is the first study to directly compare the cost of successful CELS to traditional laparoscopic colectomy in the surgical management of benign colon polyps within a single institution. Future studies will evaluate both short and long term costs using intention to treat analysis and a larger sample size.