American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Laparoscopic and open surgery go head-to-head

OCTOBER 24, 2017
Clinical Congress Daily Highlights, Tuesday First Edition

Laparoscopic surgery has risen rapidly across numerous surgical specialties in the past few years. Three recent studies examine its impact in pediatric ureter reconstruction, benign esophageal repair, and colorectal surgery in terms of reimbursement and complication rates. Presented in three different Scientific Forum sessions, their results are described briefly below:

1.One study found no difference in 30-day postoperative complication rates for laparoscopy compared with open surgery for two common procedures of the pediatric ureter— ureteroneocystostomy (920) and pyeloplasty (625).

Examining all cases in the Pediatric NSQIP database for 2014, researchers led by Austin G. Hester, MD, Wake Forest University, Winston-Salem, NC, reported significantly shorter operative times for open surgery vs. laparoscopy (pyeloplasty: 142 minutes vs. 202 minutes; ureteroneocystostomy: 157 minutes vs. 181 minutes). Other variables measured included sepsis, blood transfusion, and readmission rate. For ureteroneocystostomy, the researchers concluded, selection of surgical approach warrants further investigation, along with a more detailed cost-benefit analysis.

2. Francisco Schlottmann, MD, University of North Carolina at Chapel Hill, NC, and colleagues reviewed records for 79,622 adult patients treated between 2000 and 2013 for one of three benign esophageal disorders:  paraesophageal hernia (PEH), gastroesophageal reflux disease (GERD), and achalasia.

The study found complication rates for PEH repair fell from 26.5 percent to 10 percent as the rate of laparoscopic procedures increased from 4.9 percent to 91.4 percent. For fundoplication procedures that trend was reversed: complications rose from 5.7 percent to 12.7 percent as laparoscopic procedures increased from 24.2 percent to 78.3 percent.  PEH repair and fundoplication accounted for more than 97 percent of procedures.

3. Reimbursement for laparoscopic colorectal surgery is comparatively lower than for open procedures from both federal and commercial payors across 10 common colorectal procedures, a study of 2015 commercial and Centers for Medicare and Medicaid Services (CMS) payment data concludes.

Researchers led by Deborah S. Keller, MD, Baylor University Medical Center, Dallas, TX, found that CMS reimbursed less for laparoscopic approaches than open in six procedures (range, $9-$384). For the four procedures in which laparoscopy received higher reimbursement, the amount was not substantial ($6-$204). Among commercial payers, laparoscopic approaches were reimbursed less than open for three procedures (range, $481-$773). In the seven procedures for which laparoscopy had higher physician payments, the amount was not substantial (range, $185-$1,084). CMS payments were consistently lower than commercial, with correspondingly lower payment for laparoscopic approach.

The researchers concluded by calling for a paradigm shift to align payment with effort involved for laparoscopy. Incentivizing surgeons to use minimally invasive approaches could further increase utilization and improve overall outcomes, cost, and quality in the move to a value-based payment system, they said.

Additional Information:
These three Scientific Forum studies were presented October 24 at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA.  Program, webcast and audio information is available online at FACS.org/clincon2017. View the full abstracts here: Abstract 1, Abstract 2, Abstract 3.

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