Healthcare Resource Utilization After Surgical Treatment of Cancer: Value of Minimally Invasive Surgery

Rocco Ricciardi; Robert Neil Goldstone; Todd Francone; Matthew Wszolek; Hugh Auchincloss; Alexander de Groot; I-Fan Shih; Yanli Li

doi:10.1007/s00464-022-09189-8

Healthcare Resource Utilization After Surgical Treatment of Cancer: Value of Minimally Invasive Surgery

Surg Endosc. 2022 Oct;36(10):7549-7560. doi: 10.1007/s00464-022-09189-8. Epub 2022 Apr 21.

Authors

Rocco Ricciardi¹, Robert Neil Goldstone², Todd Francone², Matthew Wszolek³, Hugh Auchincloss⁴, Alexander de Groot⁵, I-Fan Shih⁵, Yanli Li⁵

Affiliations

¹ Section of Colon & Rectal Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, WACC 460, Boston, MA, USA. Rricciardi1@mgh.harvard.edu.
² Section of Colon & Rectal Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, WACC 460, Boston, MA, USA.
³ Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Global Access, Value, & Economics, Intuitive Surgical, Sunnyvale, CA, USA.

Abstract

Background: As the US healthcare system moves towards value-based care, hospitals have increased efforts to improve quality and reduce unnecessary resource use. Surgery is one of the most resource-intensive areas of healthcare and we aim to compare health resource utilization between open and minimally invasive cancer procedures.

Methods: We retrospectively analyzed cancer patients who underwent colon resection, rectal resection, lobectomy, or radical nephrectomy within the Premier hospital database between 2014 and 2019. Study outcomes included length of stay (LOS), discharge status, reoperation, and 30-day readmission. The open surgical approach was compared to minimally invasive approach (MIS), with subgroup analysis of laparoscopic/video-assisted thoracoscopic surgery (LAP/VATS) and robotic (RS) approaches, using inverse probability of treatment weighting.

Results: MIS patients had shorter LOS compared to open approach: - 1.87 days for lobectomy, - 1.34 days for colon resection, - 0.47 days for rectal resection, and - 1.21 days for radical nephrectomy (all p < .001). All MIS procedures except for rectal resection are associated with higher discharge to home rates and lower reoperation and readmission rates. Within MIS, robotic approach was further associated with shorter LOS than LAP/VATS: - 0.13 days for lobectomy, - 0.28 days for colon resection, - 0.67 days for rectal resection, and - 0.33 days for radical nephrectomy (all p < .05) and with equivalent readmission rates.

Conclusion: Our data demonstrate a significant shorter LOS, higher discharge to home rate, and lower rates of reoperation and readmission for MIS as compared to open procedures in patients with lung, kidney, and colorectal cancer. Patients who underwent robotic procedures had further reductions in LOS compare to laparoscopic/video-assisted thoracoscopic approach, while the reductions in LOS did not lead to increased rates of readmission.

Keywords: Cancer; Laparoscopic surgery; Length of stay; Minimally invasive surgery; Readmission; Robotic-assisted surgery.

MeSH terms

Delivery of Health Care
Humans
Length of Stay
Minimally Invasive Surgical Procedures / methods
Rectal Neoplasms* / surgery
Retrospective Studies
Robotic Surgical Procedures* / methods
Treatment Outcome