Multicenter Stratified Comparison of Hospital Costs Between Laparoscopic and Open Colorectal Cancer Resections Influence of Tumor Location and Operative Risk

Objective: To 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. Background: Laparoscopic 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. Methods: Retrospective 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. Results: Total 90-day hospital costs ranged from (sic)10474 to (sic)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 (sic)409 (< 75 years ASA I-II) to (sic)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 (sic)501 (< 75 years ASA I-II) to (sic)2515 (>= 75 years ASA III-IV). Conclusions: Laparoscopic 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.