Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016;11(1):14-21.
doi: 10.5114/wiitm.2016.58617. Epub 2016 Mar 16.

Cost minimization analysis of laparoscopic surgery for colorectal cancer within the enhanced recovery after surgery (ERAS) protocol: a single-centre, case-matched study

Michał Pędziwiatr  1 , Mateusz Wierdak  1 , Michał Nowakowski  2 , Magdalena Pisarska  1 , Maciej Stanek  1 , Michał Kisielewski  1 , Maciej Matłok  1 , Piotr Major  1 , Stanisław Kłęk  3 , Andrzej Budzyński  1
Affiliations

Cost minimization analysis of laparoscopic surgery for colorectal cancer within the enhanced recovery after surgery (ERAS) protocol: a single-centre, case-matched study

Michał Pędziwiatr et al. Wideochir Inne Tech Maloinwazyjne. 2016.

Abstract

Introduction: The goal of modern medical treatment is to provide high quality medical care in a cost-effective environment.

Aim: To assess the cost-effectiveness of laparoscopic colorectal surgery combined with the enhanced recovery after surgery protocol (ERP) in Poland.

Material and methods: We designed a single-centre, case-matched study. Economic and clinical data were collected in 3 groups of patients (33 patients in each group): group 1 - patients undergoing laparoscopy with ERP; group 2 - laparoscopy without ERP; group 3 - open resection without ERP. An independent administrative officer, not involved in the treatment process, matched patients for age, sex and type of resection. Primary outcome was cost analysis. It was carried out incorporating institutional costs: hospital bed stay, anaesthesia, surgical procedure and equipment, drugs and complications. Secondary outcomes were length of stay (LOS), readmission and complication rate.

Results: Cost of laparoscopic procedure alone was significantly more expensive than open resection. However, implementation of the ERAS protocol reduced additional costs. Total cost per patient in group 1 was significantly lower than in groups 2 and 3 (EUR 1826 vs. EUR 2355.3 vs. EUR 2459.5, p < 0.0001). Median LOS was 3, 6 and 9 days in groups 1, 2 and 3 respectively (p < 0.001). Postoperative complications were noted in 5 (15.2%), 6 (18.2%) and 13 (39.4%) patients in groups 1, 2, 3 respectively (p = 0.0435).

Conclusions: In a low medical care expenditure country, minimally invasive surgery combined with ERP can be a safe and a cost-effective alternative to open surgery with traditional perioperative care.

Keywords: colorectal cancer; enhanced recovery; fast-track; laparoscopy; perioperative management; postoperative complications.

PubMed Disclaimer

References

    1. Bonjer HJ, Hop WCJ, Nelson H, et al. Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg. 2007;142:298–303. - PubMed
    1. van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14:210–8. - PubMed
    1. Leake PA, Pitzul K, Roberts PO, Plummer JM. Comparative analysis of open and laparoscopic colectomy for malignancy in a developing country. World J Gastrointest Surg. 2013;5:294–9. - PMC - PubMed
    1. Jayne DG, Thorpe HC, Copeland J, et al. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg. 2010;97:1638–45. - PubMed
    1. Baigrie RJ, Stupart D. Introduction of laparoscopic colorectal cancer surgery in developing nations. Br J Surg J. 2010;97:625–7. - PubMed

LinkOut - more resources