A new perspective on the value of minimally invasive colorectal surgery-payer, provider, and patient benefits.
BACKGROUND
The clinical benefits of minimally invasive surgery (MIS) are proven, but overall financial benefits are not fully explored. Our goal was to evaluate the financial benefits of MIS from the payer's perspective to demonstrate the value of minimally invasive colorectal surgery.


METHODS
A Truven MarketScan® claim-based analysis identified all 2013 elective, inpatient colectomies. Cases were stratified into open or MIS approaches based on ICD-9 procedure codes; then costs were assessed using a similar distribution across diagnosis related groups (DRGs). Care episodes were compared for average allowed costs, complication, and readmission rates after adjusting costs for demographics, comorbidities, and geographic region.


RESULTS
A total of 4615 colectomies were included-2054 (44.5 %) open and 2561 (55.5 %) MIS. Total allowed episode costs were significantly lower MIS than open ($37,540 vs. $45,284, p < 0.001). During the inpatient stay, open cases had significantly greater ICU utilization (3.9 % open vs. 2.0 % MIS, p < 0.001), higher overall complications (52.8 % open vs. 32.3 % MIS, p < 0.001), higher colorectal-specific complications (32.5 % open vs. 17.9 % MIS, p < 0.001), longer LOS (6.39 open vs. 4.44 days MIS, p < 0.001), and higher index admission costs ($39,585 open vs. $33,183 MIS, p < 0.001). Post-discharge, open cases had significantly higher readmission rates/100 cases (11.54 vs. 8.28; p = 0.0013), higher average readmission costs ($3055 vs. $2,514; p = 0.1858), and greater 30-day healthcare costs than MIS ($5699 vs. $4357; p = 0.0033). The net episode cost of care was $7744/patient greater for an open colectomy, even with similar DRG distribution.


CONCLUSIONS
In a commercially insured population, the risk-adjusted allowed costs for MIS colectomy episodes were significantly lower than open. The overall cost difference between MIS and open was almost $8000 per patient. This highlights an opportunity for health plans and employers to realize financial benefits by shifting from open to MIS for colectomy. With increasing bundled payment arrangements and accountable care sharing programs, the cost impact of shifting from open to MIS introduces an opportunity for cost savings.
['Keller|Deborah S|DS|', 'Senagore|Anthony J|AJ|', 'Fitch|Kathryn|K|', 'Bochner|Andrew|A|', 'Haas|Eric M|EM|']
D000293:Adolescent D000328:Adult D003082:Colectomy D003953:Diagnosis-Related Groups D005260:Female D017048:Health Care Costs D006760:Hospitalization D006801:Humans D007349:Insurance, Health, Reimbursement D008297:Male D008875:Middle Aged D019060:Minimally Invasive Surgical Procedures D010359:Patient Readmission D011183:Postoperative Complications D012189:Retrospective Studies D020379:Risk Adjustment D014481:United States D055815:Young Adult
Financial benefits Minimally invasive colorectal surgery Cost shifting Healthcare outcomes Open colorectal surgery