A Medical Device Daily

Ethicon Endo-Surgery (Cincinnati) reported results from two newly published studies that demonstrate a minimally invasive approach in three common procedures resulted in a reduced rate of complications and lower overall cost of care, including a difference of more than $15,000 on average for minimally invasive colectomies, when compared to open surgery.

One study compared two types of minimally invasive hysterectomy procedures to open abdominal hysterectomy and another study analyzed outcomes of minimally invasive approaches for appendectomy and colectomy procedures compared to open surgery.

The study titled "Open Abdominal versus Laparoscopic and Vaginal Hysterectomy: Analysis of a Large United States Payer Measuring Quality and Cost of Care" showed, in line with previous studies, minimally invasive hysterectomy reduced rates of postoperative infection and length of stay in the hospital when compared to open abdominal hysterectomy.

Open surgery was also associated with higher costs than those who underwent laparoscopic and vaginal hysterectomy. Given these findings, the company said that the study authors concluded a substantial opportunity exists to shift more hysterectomies from an in-patient to an outpatient setting while maintaining or improving the clinical outcome for patients.

"The clinical and economic outcomes of the study demonstrate the need for higher adoption of minimally invasive hysterectomy procedures in patients who are candidates for this approach," said Lori Warren, MD, lead author of the study and an advanced gynecologic laparoscopic surgeon with Women First of Louisville (St. Matthews, Kentucky).

Warren added that "In this age of comparative effectiveness, this study shows that when it comes to hysterectomy, a minimally invasive approach gives physicians the opportunity to increase the quality of care women are receiving while potentially saving the healthcare system millions of dollars. Clinicians who have had concerns that minimally invasive procedures may be riskier for patients should be reassured because this real-world data demonstrates the overall complication rate is actually higher with the open abdominal approach."

When compared with patients that underwent an open abdominal hysterectomy, the vaginal approach was associated with an average cost-savings of more than $4,000 and laparoscopic hysterectomy an average of $2,000 in cost-savings. Among the three methods of hysterectomy, open abdominal hysterectomy remains the most common approach as 70% of procedures are still performed in this manner, despite the clear benefits of minimally invasive approaches. The retrospective analysis was performed on 15,404 patients using claims data from a large U.S. managed care plan. The results of the study, which was sponsored by Ethicon, were published in the September issue of The Journal of Minimally Invasive Gynecology.

In similar findings, another study titled "Comparison of the Clinical and Economic Outcomes Between Open and Minimally Invasive Appendectomy and Colectomy: Evidence from a Large Commercial Payer Database" concluded minimally invasive appendectomy and colectomy were associated with lower infection rates, fewer complications, shorter hospital stays and lower expenditures than open surgery. The results of the retrospective analysis, which was also sponsored by Ethicon, has been accepted for publication in the peer-reviewed journal Surgical Endoscopy and is currently available on the journal's Web site. The data included analysis of 7,532 appendectomy and 2,745 colectomy procedures using a large commercial payer database.

Investigators of the study collected data on intraoperative and postoperative complications, length of stay, rates of readmission, and insurer and patient payment totals for inpatient and outpatient procedures. Of 15,404 patients, MIP was performed in 43% of subjects, with 23% (3,520) undergoing laparoscopic hysterectomy, and 20% (3,130) a vaginal hysterectomy. The study demonstrated that postoperative infection rates were higher for patients undergoing open abdominal hysterectomy: 18% as compared with 15% of laparoscopic and 14% of patients undergoing vaginal hysterectomy (P<.05 with open abdominal hysterectomy average length of stay was days versus and for patients undergoing mip laparoscopic vaginal respectively.>

In addition to the clinical benefits, the data indicated costs associated with MIP were lower than for patients undergoing open abdominal hysterectomy. Healthcare spending, represented as the expenditures for inpatient and outpatient care associated with the procedure, included expenses related to surgical and medical therapy. Adjusted expenditures associated with outpatient MIP were markedly lower than expenditures for inpatient open abdominal hysterectomy, indicating significant savings can be realized when patients can be treated with an MIP procedure in an outpatient setting rather than undergoing an inpatient procedure – MIP or open. When adjusting for the setting, the cost of outpatient laparoscopic hysterectomy averaged $9,426 and vaginal hysterectomy $7,627 compared to $11,739 for inpatient open hysterectomy.