Cost comparison of laparoscopic versus open surgery for common procedures in Rwandan teaching hospitals

Abstract

Objective: This study evaluates the economic and clinical impacts of minimally invasive surgery (MIS) compared to open surgery (Open S) for four common procedures-appendectomy, cholecystectomy, hernia repair, and ovarian cystectomy-at two major teaching hospitals in Rwanda, RMRTH and CHUK. The aim is to assess direct costs, hospital stays, complications, and recovery times for MIS versus Open S and to explore the role of health insurance in MIS accessibility.

Methods: A retrospective analysis was conducted on data from 206 patients treated between 2019 and 2022, with 100 undergoing Open S and 106 receiving MIS. Data included direct costs, hospital stay lengths, post-operative complications, and recovery times. The study also examined the correlation between MIS utilization and health insurance.

Results: The average patient age was 41.7 years, with nearly equal gender distribution (52.4 % male, 47.6 % female). Most patients (79.1 %) had Community-Based Health Insurance coverage. Laparoscopic cholecystectomy showed significant economic advantages, with shorter stays, fewer complications, and faster recovery (p < 0.02). MIS for hernia repair offered quicker recovery but incurred higher costs. For appendectomy and ovarian cystectomy, there was no significant cost difference between MIS and Open S. A strong positive correlation was found between MIS adoption rates and health insurance, supporting improved access.

Conclusion: MIS in Rwanda shows promise for economic savings, better patient outcomes, and expanded access through insurance. However, challenges like high consumable costs and limited expertise need to be addressed to fully optimize MIS benefits in Rwanda's healthcare system.

Keywords: Clinical outcome; Cost comparison; Health insurance; Healthcare accessibility; Healthcare costs; Laparoscopy; Open surgery.