Clinical Evidence

Quality Of Life

Evidence from quality of life studies is inconsistent; with a recent systematic review reporting that some studies suggest no significant difference, whilst others suggest a significant quality of life benefit with the laparoscopic approach.

Readmission Rates

Readmission rates are typically lower, but not significant, in patients undergoing laparoscopic colorectal resection than in those undergoing open colorectal resection.([FOOTNOTE=Fowler DL, White A. Laparoscopy-assisted sigmoid resection. Surg Laparosc Endosc. 1991 Sep;1(3):183-8.],[ANCHOR=],[LINK=]),([FOOTNOTE=Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991 Sept;1: 144–150.],[ANCHOR=],[LINK=])

Rates of readmission are influenced by several factors including BMI, surgeon volume, operating time and presence of SSI; ([FOOTNOTE=Manilich E, Vogel JD, Kiran RP, et al. Key factors associated with postoperative complications in patients undergoing colorectal surgery. Dis Colon Rectum. 2013 Jan;56(1):64-71.],[ANCHOR=],[LINK=]),([FOOTNOTE=Wick EC, Shore AD, Hirose K, et al. Readmission rates and cost following colorectal surgery. Dis Colon Rectum. 2011 Dec;54(12):1475-9.],[ANCHOR=],[LINK=])  increased BMI is also associated with an increased surgical difficulty and significantly increased risk for SSI.([FOOTNOTE=Yang T, Wei M, He Y, Deng X, Wang Z. Impact of visceral obesity on outcomes of laparoscopic colorectal surgery: a meta-analysis. ANZ J Surg. 2015 Apr 22. doi: 10.1111/ans.13132. [Epub ahead of print]],[ANCHOR=],[LINK=]),([FOOTNOTE=Wick EC, Hirose K, Shore AD, et al. Surgical site infections and cost in obese patients undergoing colorectal surgery. Arch Surg. 2011 Sep;146(9):1068-72.],[ANCHOR=],[LINK=])

Trends In Cost Studies

In published cost studies the percentage difference between laparoscopic and open colectomy varies widely, but for studies conducted in Western settings there is a trend toward a decline in the cost of laparoscopic colectomy over time.

Surgeon Volume

Higher surgeon volume is associated with better outcomes and lower costs compared with low volume surgeons.

Emerging Markets

Clinical outcomes reported in studies of laparoscopic versus open colectomy in emerging markets such as India and Brazil are similar to outcomes reported in Europe and North America.([FOOTNOTE=Lacy AM, Delgado S, García-Valdecasas JC, et al. Port site metastases and recurrence after laparoscopic colectomy. A randomized trial. Surg Endosc. 1998 Aug;12(8):1039-42.],[ANCHOR=],[LINK=])

Pulmonary Complications

Laparoscopic surgery is associated with lower absolute risk of pulmonary complications versus open surgery.([FOOTNOTE=Owen RM, Perez SD, Lytle N, et al. Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy. Surg Endosc. 2013 Oct;27(10):3555-63.],[ANCHOR=],[LINK=])

Clinical Outcomes

Operating Time

Longer operating time is not associated with significantly higher costs.15

Total Costs

Findings from cost studies are inconsistent. In instances where total costs were lower with laparoscopic versus open colorectal surgery the cost savings were primarily driven by lower complication rates.

Savings Due To Clinical Benefits

Clinical benefits of laparoscopic colectomy, including shorter length of stay and lower rates of postoperative complications translate into economic benefits, which are important from the payer perspective.

Economic Outcomes

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