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Effects of laparoscopic vs open abdominal surgery on costs and hospital readmission rate and its effect modification by surgeons’ case volume

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Abstract

Background

Laparoscopy provides a minimally invasive alternative to open abdominal surgery. Current data describing its association with hospital readmission and costs in relation to surgeon laparoscopic case volume is limited to smaller databases and subsets of operations.

Methods

This retrospective cohort study of 23,285 adult abdominal operations from 2007 to 2015 compares 30-day readmission rate and costs between laparoscopic and open abdominal operations and examines effect modification by surgeon laparoscopic case volume. Outcomes were all-cause hospital readmission within 30 days after discharge and index hospital admission cost.

Results

All-cause hospital readmission rates were significantly lower after laparoscopic abdominal operations compared with open operations (adjusted odds ratio [aOR] 0.56, 95% CI 0.46–0.69, p < 0.001) with a difference in readmission risk attributable to laparoscopic approach of − 4.0% (95% CI − 5.4 to − 2.6%) in complete-case analysis. Among surgeons with a high laparoscopic case volume, the estimated difference in readmission risk through laparoscopy was magnified (− 5.8%, 95% CI − 7.5 to − 4.1%) compared to low surgeon laparoscopic case volume (− 2.9%, 95% CI − 4.8 to −1.1%, p for interaction = 0.005). The estimated difference in costs of the index hospital admission attributable to laparoscopic approach was − $3869 (95% CI − $4200 to − $3538; adjusted incidence rate ratio 0.77, 95% CI 0.75–0.79, p < 0.001). Laparoscopy was followed by significantly lower rates of readmissions related to gastrointestinal (aOR 0.68, 95% CI 0.55–0.85, p = 0.001), wound complications (infection: aOR 0.33, 95% CI 0.23–0.47, p < 0.001; non-infectious: aOR 0.47, 95% CI 0.30–0.74, p = 0.001), and malignancy (aOR 0.68, 95% CI 0.55–0.85, p < 0.001). The findings remain robust after multiple imputation and sensitivity analyses.

Conclusions

Laparoscopy versus open abdominal surgery is associated with reduced hospital readmissions related to malignancy, gastrointestinal, and wound complications. Effect modification by higher laparoscopy case volume argues for continued proliferation of laparoscopy in abdominal surgeries.

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Acknowledgments

The authors would like to acknowledge Dr. Christina H. Shin and Sara M. Burns for assistance with statistical analyses and scientific discourse.

Funding

This work was supported by Jeffrey and Judith Buzen in an unrestricted grant (philanthropic donation) to Matthias Eikermann.

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Author notes

  1. Thomas H. Shin and Sabine Friedrich equally contributed towards this study.

Authors and Affiliations

  1. Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Thomas H. Shin

  2. Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA

    Sabine Friedrich, Maira I. Rudolph & Timothy T. Houle

  3. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, Masco 415, Boston, MA, 02214, USA

    Sabine Friedrich, Ronny Munoz-Acuna & Matthias Eikermann

  4. Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Gabriel A. Brat

  5. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA

    Vicki Sein & Cristina R. Ferrone

  6. Department of Anesthesiology, Universitätsklinikum, Essen, Germany

    Matthias Eikermann

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Disclosures

This work was supported by Jeffrey and Judith Buzen in an unrestricted grant to Matthias Eikermann. The funders had no role in the design and conduct of the study, the collection, management, analysis, and interpretation of the data, the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. Dr. T. Houle reports grants from NINDS (PI), grants from NIGMS, personal fees from Headache, personal fees from Anesthesiology, personal fees from Cephalalgia, outside the submitted work. Dr. E. Eikermann received funding for investigator-initiated trials from Merck, and received honorarium for giving advice to Merck, he holds equity of Calabash Bioscience Inc., and is an Associate Editor of the British Journal of Anaesthesia. Drs. T. Shin, G. Brat, V. Sein, R. Munoz-Acuna, and C. Ferrone as well as Ms. S. Friedrich and M. Rudolph have no conflicts of interest or financial ties to disclose.

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Shin, T.H., Friedrich, S., Brat, G.A. et al. Effects of laparoscopic vs open abdominal surgery on costs and hospital readmission rate and its effect modification by surgeons’ case volume. Surg Endosc 34, 1–12 (2020). https://doi.org/10.1007/s00464-019-07222-x

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