Laparoscopic Nephrectomy

While initial evaluations of laparoscopic nephrectomy found that the technique was more costly than open nephrectomy (1,27), we found that reductions in operative time and length of stay have allowed laparoscopic nephrectomy to be cost superior (Table 1) (2,14). Sensitivity analyses demonstrate that laparoscopic nephrectomy is cost superior with length of stay less than four days and operative time less than four hours (Fig. 1). Patients after laparoscopic nephrectomy are routinely discharged in less than four days (2,21,28,29) and operative times by experienced laparoscopists are invariably less than four hours (2,20-23). Short operative times can also compensate for increased equipment costs (Fig. 2).

As such, laparoscopic nephrectomy is a cost superior procedure when evaluating both direct and indirect costs.

At this time, however, robot-assisted prostatectomy is significantly more costly than open surgery due to the cumulative added expense of robot purchase and maintenance, along with individual case equipment costs.

As such, laparoscopic nephrectomy is a cost superior procedure when evaluating both direct and indirect costs.

TABLE 1 ■ Cost Comparison of Open and Laparoscopic Nephrectomy

Laparoscopic nephrectomy (mean ± SD)

Open nephrectomy (mean ± SD)

p valuea

Anesthesiologist feesb

348 ± 64

335 ± 36

0.625

Surgeon's feesc

1152

1474

<0.001d

Total OR (OR costs + supplies/

3557± 759

2487 ± 271

0.003d

OR costs

2435 ± 496

2332 ± 283

0.625

Surgical supplies

1122±361

155 ± 65

<0.001d

Anesthesia costs (hospital)

229 ± 34

260 ± 37

0.075

Length of stay (day)

3.3 ± .91

6.1 ± 1.73

<0.001

Room and boarde

1293±357

2419±682

<0.001

Studies (laboratory/radiology)

136 ± 31

255 ± 53

<0.001

Pharmacy (medications + supplies)

232± 110

484± 154

<0.001

Intravenous solutions

112 ± 66

315± 152

<0.001

Infusion pump

36 ± 24

93 ± 68

0.02

Hospital costs (all inclusive)

5968±977

6870± 1182

0.097

Overall cost (hospital costs + professional fees)

7468 ± 1036

8679± 1195

0.037

aStudent's t-test unless otherwise indicated.

bAnesthesiologist fees based on 2000 Medicare (Texas) reimbursement rates of $18 per unit. cSurgeon fees based on 2000 Medicare reimbursement. dMann-Whitney Rank Sum test. eRoom and board cost is $395 per day.

laparoscopic supplies include such disposable costs as: one Veress needle, one Visiport device, two to three disposable trocars, two to three endovascular staplers, one to two 5-mm clip appliers, and one laparoscopic sack. Abbreviation: OR, operating room. Source: From Ref. 2.

aStudent's t-test unless otherwise indicated.

bAnesthesiologist fees based on 2000 Medicare (Texas) reimbursement rates of $18 per unit. cSurgeon fees based on 2000 Medicare reimbursement. dMann-Whitney Rank Sum test. eRoom and board cost is $395 per day.

laparoscopic supplies include such disposable costs as: one Veress needle, one Visiport device, two to three disposable trocars, two to three endovascular staplers, one to two 5-mm clip appliers, and one laparoscopic sack. Abbreviation: OR, operating room. Source: From Ref. 2.

3 160

3 160

Length of hospitalisation for laparoscop

FIGURE 1 ■ Two-way sensitivity analysis comparing costs for different operating times and lengths of hospitalization for laparoscopic nephrectomy. Source: From Ref. 2.

Length of hospitalisation for laparoscop

Length of hospitalisation for laparoscopic Nx

FIGURE 1 ■ Two-way sensitivity analysis comparing costs for different operating times and lengths of hospitalization for laparoscopic nephrectomy. Source: From Ref. 2.

FIGURE2 ■ Two-way sensitivity analysis comparing different costs of laparoscopic equipment and lengths of hospitalization for laparoscopic nephrectomy. Source: From Ref. 2.

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