Community-based appraisal of laparoscopic abdominal surgery in Japan

Kazuaki Kuwabara, Shinya Matsuda, Kiyohide Fushimi, Koichi B. Ishikawa, Hiromasa Horiguchi, Kenji Fujimori

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

Background: Despite the prevalence of laparoscopic surgery (LS), community-based appraisal of its benefit over open surgery (OS) has not been performed. This can be measured by increased total charge (TC) spent and decreased length of stay (LOS), which are indicative of greater resource use and opportunistic cost reduction. We prioritized the value of LS for eight abdominal procedures. Materials and methods: We used a Japanese administrative database for the 6 mo leading up to December 2007. Study procedures were appendectomy, cholecystectomy, choledocholithotomy, herniorrhaphy, colectomy, partial or total gastrectomy, and small bowel resection (SBR) in adults. We analyzed patient demographics, mortality, comorbidity, complications, use of chemotherapy or postoperative pain control, hospital teaching status, postoperative LOS, and TCs. The impact of LS was determined using multivariate analysis on the propensity-score-matched cohorts of LS and OS. Results: Herniorrhaphy was most frequently performed (24,088 cases), whereas SBR was performed least (3404). LS was performed most often in cholecystectomy (81%) and least in herniorrhaphy (3.7%). LS did not increase complications in any procedure. Laparoscopic cholecystectomy and SBR were associated with shorter LOS and lower TC, whereas laparoscopic herniorrhaphy increased LOS and TC. Laparoscopic appendectomy and partial gastrectomy reduced LOS and increased TC. Conclusions: LS safety was confirmed. Laparoscopic cholecystectomy or SBR might have advantages, whereas laparoscopic was no better than open herniorrhaphy and might be decided by patient's preference. Considering the variation in the decremental opportunistic cost produced by incremental medical expenses observed among the procedures, policymakers should determine an appropriate reimbursement schedule.

Original languageEnglish
Pages (from-to)e1-e13
JournalJournal of Surgical Research
Volume165
Issue number1
DOIs
Publication statusPublished - 2011 Jan
Externally publishedYes

Keywords

  • Economic appraisal
  • Health services
  • Laparoscopic surgery
  • Outcomes research
  • Prioritization

ASJC Scopus subject areas

  • Surgery

Fingerprint Dive into the research topics of 'Community-based appraisal of laparoscopic abdominal surgery in Japan'. Together they form a unique fingerprint.

Cite this