Need Surgery? Check out the Minimally Invasive Version

Laparoscopic surgery might be safer and less expensive than open surgery

(RxWiki News) A few small incisions or one big one — that's the main difference between laparoscopic surgery and routine surgical procedures. And it could help patients save on health care costs.

A new study found that switching to laparoscopic surgery could save patients money. And it could also decrease complications.

The authors of this study noted that in many hospitals, even patients who would be candidates for laparoscopic surgery receive traditional open surgery instead. These researchers said hospitals should retrain surgeons to encourage the change.

However, Adam C. Powell, PhD, a health care economist and president of Payer+Provider, told dailyRx News that hospitals don't necessarily have to train surgeons to reap the benefits of laparoscopic surgery.

"Given the value of minimally-invasive surgery to patients, surgeons have the incentive to learn to perform it without being subsidized to do so," Dr. Powell said. "Most fields have continuing medical education (CME) requirements, which require physicians to learn new skills. Likewise, a certain amount of education happens from peer-to-peer mentoring."

Hospitals might still have expenses, Dr. Powell noted. He said that "minimally invasive surgery requires both its own set of durable and consumable equipment, so a hospital would need to have the necessary items on hand."

Martin A. Makary, MD, a professor of surgery at the Johns Hopkins University School of Medicine, led the current study.

“Minimally invasive surgery, done in the right patients, represents an under-recognized opportunity not only for cost savings, but also for making surgery safer, reducing the very real suffering associated with surgical complications,” Dr. Makary said in a press release.

Minimally invasive laparoscopic surgery uses one or more small incisions called keyholes. These are used to insert surgical instruments and small cameras.

In contrast, traditional open surgery involves a much larger incision.

Patients who have laparoscopic surgery often have much less pain. And they often recover more quickly.

Dr. Makary and team analyzed data on three types of stomach and lung surgeries. These researchers looked at data on more than 80,000 cases, tracking billing costs for the operations.

Also, they assessed seven types of complication rates for each type of surgery. Dr. Makary and colleagues then compared the actual cost for each patient to the estimated cost if the surgery had been performed laparoscopically.

These researchers assessed cost savings in two ways. In the first scenario, they looked at savings if all hospitals increased their use of laparoscopic surgery by 50 percent. In the second scenario, they assessed savings if the hospitals that used the fewest laparoscopic surgeries increased their use.

In the first scenario, Dr. Makary and team guessed that hospitals across the nation could collectively prevent over 3,000 complications. They could also significantly reduce patients' hospital stays.

Savings could be up to $288 million a year.

In the second scenario, hospitals could prevent over 4,000 complications. They could shorten patient stays by an extra 20,000 days compared to the first scenario.

The savings could be $337 million a year.

However, not all patients are good candidates for laparoscopic surgery, Dr. Makary and team noted.

“The decision to perform an open versus minimally invasive procedure should be made according to each patient’s specific case and overall health, among other factors,” Dr. Makary said. “But our results make a very strong case that minimally invasive surgery is grossly underutilized and, at a minimum, ought to be offered to patients more often.”

This study was published March 25 in JAMA Surgery.

The study did not receive outside funding. Dr. Makary received royalties from Bloomsbury Press.

Review Date: 
March 26, 2015