Advantages of laparoscopic resection for ileocolic Crohn's disease improved outcomes and reduced costs

T. M. Young-Fadok, K. Hall Long, E. J. McConnell, G. Gomez Rey, R. L. Cabanela

Research output: Contribution to journalArticle

154 Scopus citations

Abstract

Background: Laparoscopic colorectal procedures are considered to be technically challenging, and there is a lack of consensus regarding the magnitude of their benefits. The laparoscopic approach is generally held to be more expensive. Using a model of a single procedure performed for a single indication (ileocolic resection for Crohn's disease [CD]), we set out to demonstrate the feasibility of this procedure by determining the conversion rate, documenting the patient benefits, and performing a formal cost analysis. Methods: Consecutive cases of laparoscopic ileocolic resection for CD were identified (LAP). Case-match methodology identified a series of open laparotomy controls (OPEN) that were matched for five potential confounding criteria: age, gender, diagnosis, type of resection, and date of operation. Pre-, intra-, and postoperative details were gathered. Medical resource utilization was tracked using a standardized database, and all costs were reported in 1999 dollars. Results: The conversion rate was 5.9%. Resolution of ileus occurred more rapidly in the LAP than in the OPEN group. The time to clears in the LAP group was a median of 0 days (range, 0-4) vs 3.0 days (range, 2-8) in the OPEN group (p = 0.0001). Time to regular diet was 2.0 days (range, 1-6) in the LAP group vs 5.0 days (range, 3-12) in the OPEN group (p = 0.0001). Length of hospital stay was significantly reduced in the LAP group (4.0 days [range, 2-8], vs 7.0 days [range, 3-14], p = 0.0001). The LAP group had significantly lower direct costs ($8684 vs $11,373) and indirect costs ($1358 vs $2349) than the OPEN group (p < 0.001). This resulted in total costs of $9895 for LAP vs $13,268 for OPEN (p < 0.001). Conclusion: Laparoscopic ileocolic resection for CD is feasible. There are significant postoperative benefits in terms of resolution of ileus, narcotic use, and hospital stay. This approach translates into cost savings of >$3300 for laparoscopic patients.

Original languageEnglish (US)
Pages (from-to)450-454
Number of pages5
JournalSurgical Endoscopy
Volume15
Issue number5
DOIs
StatePublished - May 1 2001

Keywords

  • Cost analysis
  • Costs
  • Crohn's disease
  • Ileocolic resection
  • Ileus
  • Laparoscopic colectomy

ASJC Scopus subject areas

  • Surgery

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    Young-Fadok, T. M., Hall Long, K., McConnell, E. J., Gomez Rey, G., & Cabanela, R. L. (2001). Advantages of laparoscopic resection for ileocolic Crohn's disease improved outcomes and reduced costs. Surgical Endoscopy, 15(5), 450-454. https://doi.org/10.1007/s004640080078