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Combined endo-laparoscopic surgery (CELS) for benign colon polyps: a single institution cost analysis

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Abstract

Background

Endoscopic removal of benign colon polyps is not always possible, even with advanced endoscopic techniques. Segmental colectomy has been the traditional therapy but is associated with an increased risk of complications and may be unnecessary since fewer than 20% of these polyps harbor malignancy. Combined endo-laparoscopic surgery (CELS) has emerged as an alternative method to address these polyps. While feasibility, safety, and improved short-term patient outcomes have been demonstrated, there has never been an evaluation of cost comparing these two approaches within a single institution.

Methods

In this observational cohort study, we compared short-term outcomes and costs of 11 patients who underwent CELS for right colon polyps with 11 patients who underwent a laparoscopic right colectomy between April 2014 and November 2017. The cost analysis covered the perioperative period from operating room to hospital discharge.

Results

A total of 11 patients underwent an attempted CELS procedure for right colon polyps with a success rate of 90% (10/11). The median length of stay (LOS) for CELS patients was 1 day. LOS for patients who underwent a laparoscopic right colectomy at TMC was 3.82 days. The median OR time for CELS was 166.73 (± 57.88) min, compared to 204.73 (± 51.49) min for a laparoscopic right colectomy. The calculated total cost for a CELS patient was $5523.29, compared to $12,626.33 for a laparoscopic right colectomy, for a cost-savings of $7103.04 per patient.

Conclusions

CELS procedures are associated with good short-term outcomes and are performed at a lower cost compared to traditional laparoscopic colectomy, with the most significant cost saver being shorter hospital LOS. This is the first study to directly compare the cost of CELS to traditional laparoscopic colectomy in the surgical management of benign colon polyps within a single institution.

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Authors and Affiliations

  1. Department of Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St, #6190, Boston, MA, 02111, USA

    Anusha Jayaram, Robert Plummer, Mengdi Yao, Lilian Chen & James Yoo

  2. Boston Medical Center, Boston University School of Medicine, Boston, MA, 02118, USA

    Nathan Barr

Authors
  1. Anusha Jayaram
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  2. Nathan Barr
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  3. Robert Plummer
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  4. Mengdi Yao
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  5. Lilian Chen
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  6. James Yoo
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Corresponding author

Correspondence to James Yoo.

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Disclosures

Anusha Jayaram, Nathan Barr, Robert Plummer, and Drs. Mengdi Yao, Lilian Chen, and James Yoo have no conflicts of interest or financial ties to disclose.

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Jayaram, A., Barr, N., Plummer, R. et al. Combined endo-laparoscopic surgery (CELS) for benign colon polyps: a single institution cost analysis. Surg Endosc 33, 3238–3242 (2019). https://doi.org/10.1007/s00464-018-06610-z

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  • DOI: https://doi.org/10.1007/s00464-018-06610-z

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