Study: Minimally invasive procedure reduces cost and complications compared to open surgery

Ethicon Endo-Surgery today announced results from two newly published studies that demonstrate a minimally invasive approach in three common procedures resulted in a reduced rate of complications and lower overall cost of care, including a difference of more than $15,000 on average for minimally invasive colectomies, when compared to open surgery.

One study compared two types of minimally invasive hysterectomy procedures to open abdominal hysterectomy(i) and another study analyzed outcomes of minimally invasive approaches for appendectomy and colectomy procedures compared to open surgery(ii).

The study titled "Open Abdominal versus Laparoscopic and Vaginal Hysterectomy: Analysis of a Large United States Payer Measuring Quality and Cost of Care" showed, in line with previous studies, minimally invasive hysterectomy reduced rates of postoperative infection and length of stay in the hospital when compared to open abdominal hysterectomy. Open surgery was also associated with higher costs than those who underwent laparoscopic and vaginal hysterectomy. Given these findings, the study authors concluded a substantial opportunity exists to shift more hysterectomies from an in-patient to an outpatient setting while maintaining or improving the clinical outcome for patients.

"The clinical and economic outcomes of the study demonstrate the need for higher adoption of minimally invasive hysterectomy procedures in patients who are candidates for this approach," said Lori Warren, M.D.,* lead author of the study and an advanced gynecologic laparoscopic surgeon with Women First of Louisville. "In this age of comparative effectiveness, this study shows that when it comes to hysterectomy, a minimally invasive approach gives physicians the opportunity to increase the quality of care women are receiving while potentially saving the healthcare system millions of dollars. Clinicians who have had concerns that minimally invasive procedures may be riskier for patients should be reassured because this real-world data demonstrates the overall complication rate is actually higher with the open abdominal approach."

When compared with patients that underwent an open abdominal hysterectomy, the vaginal approach was associated with an average cost-savings of more than $4,000 and laparoscopic hysterectomy an average of $2,000 in cost-savings. Among the three methods of hysterectomy, open abdominal hysterectomy remains the most common approach as 70 percent(iii) of procedures are still performed in this manner, despite the clear benefits of minimally invasive approaches. The retrospective analysis was performed on 15,404 patients using claims data from a large U.S. managed care plan. The results of the study, which was sponsored by Ethicon Endo-Surgery, were published in the September issue of The Journal of Minimally Invasive Gynecology.

In similar findings, another study titled "Comparison of the Clinical and Economic Outcomes Between Open and Minimally Invasive Appendectomy and Colectomy: Evidence from a Large Commercial Payer Database" concluded minimally invasive appendectomy and colectomy were associated with lower infection rates, fewer complications, shorter hospital stays and lower expenditures than open surgery. The results of the retrospective analysis, which was also sponsored by Ethicon Endo-Surgery, has been accepted for publication in the peer-reviewed journal Surgical Endoscopy and is currently available on the journal's Web site. The data included analysis of 7,532 appendectomy and 2,745 colectomy procedures using a large commercial payer database.

"This data strongly suggests that if someone needs a colectomy, regardless of age, a minimally invasive procedure will result in fewer complications, get them out of the hospital several days sooner and cost the healthcare system $15,000 less than if the patient underwent open surgery," said Terrence Fullum, M.D*., Associate Professor of Surgery at Howard University College of Medicine and lead author of the study. "Unfortunately, there is a great disparity between the number of colectomy procedures performed with open surgery compared to minimally invasive procedures. This study is the latest in a substantial and growing body of clinical and economic evidence that I believe supports a call to action among the entire healthcare community to increase access to the benefits of minimally invasive colectomy."

About "Open Abdominal versus Laparoscopic and Vaginal Hysterectomy: Analysis of a Large United States Payer Measuring Quality and Cost of Care"

Investigators of the study collected data on intraoperative and postoperative complications, length of stay, rates of readmission, and insurer and patient payment totals for inpatient and outpatient procedures. Of 15,404 patients, MIP was performed in 43 percent of subjects, with 23 percent (3,520) undergoing laparoscopic hysterectomy, and 20 percent (3,130) a vaginal hysterectomy. The study demonstrated that postoperative infection rates were higher for patients undergoing open abdominal hysterectomy: 18 percent as compared with 15 percent of laparoscopic and 14 percent of patients undergoing vaginal hysterectomy (P<.05). With open abdominal hysterectomy, average length of stay was 3.7 days versus 1.6 and 2.2 for patients undergoing MIP laparoscopic and MIP vaginal hysterectomy, respectively.

In addition to the clinical benefits, the data indicated costs associated with MIP were lower than for patients undergoing open abdominal hysterectomy. Healthcare spending, represented as the expenditures for inpatient and outpatient care associated with the procedure, included expenses related to surgical and medical therapy. Adjusted expenditures associated with outpatient MIP were markedly lower than expenditures for inpatient open abdominal hysterectomy, indicating significant savings can be realized when patients can be treated with an MIP procedure in an outpatient setting rather than undergoing an inpatient procedure - MIP or open. When adjusting for the setting, the cost of outpatient laparoscopic hysterectomy averaged $9,426 and vaginal hysterectomy $7,627 compared to $11,739 for inpatient open hysterectomy.

About "Comparison of the Clinical and Economic Outcomes Between Open and Minimally Invasive Appendectomy and Colectomy: Evidence from a Large Commercial Payer Database"

Investigators analyzed medical and pharmacy claims data from a large U.S. managed health care insurer and measured post-operative infection rates, procedure-specific complications, length of hospital stay, readmission rates and expenditure rates. The data included 2,745 patients who underwent colectomies; 842 (31 percent) were treated using a minimally invasive approach whereas 1,903 (69 percent) underwent open surgery. Post-operative infection rates for those who underwent an MIP were lower (24 percent) than those who had open surgery (38 percent) as were minor (17 percent vs. 23 percent) and major bleed rates (4 percent vs. 10 percent). When measuring the predicted length of stay (with adjustments for factors such as surgical approach, patient age, and co-morbidities), the data indicated open surgery resulted in a length of stay four days longer when compared to MIP. Overall, the investigators concluded minimally invasive colectomy procedures were associated with a cost of care $15,200 less than open surgery.

When assessing these same outcomes for open and minimally invasive appendectomies the investigators found similar results. The data on 7,532 patients who underwent appendectomies included 5,304 (70 percent) who underwent an MIP and 2,228 (30 percent) treated with open abdominal surgery. Post operative infection rates (16 percent for MIP vs. 20 percent for open) and overall procedure specific complication rates (2.51 percent for MIP vs. 3.82 for open) were lower for minimally invasive procedures when compared with open surgery. Additionally, minimally invasive appendectomy was associated with a lower cost of care ($700) and about a half day shorter hospital stay (3.27 vs. 3.91 days) than open surgery.

SOURCE Ethicon Endo-Surgery