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Impact of laparoscopic versus open surgery on hospital costs for colon cancer: a population-based retrospective cohort study
  1. Mauro Laudicella1,
  2. Brendan Walsh1,
  3. Aruna Munasinghe2,
  4. Omar Faiz3
  1. 1School of Health Sciences, University of London, London, UK
  2. 2Department of Surgery and Cancer, Imperial College London, London, UK
  3. 3Surgical Epidemiology Trials and Outcomes Centre, St Mark's Hospital and Academic Institute, Harrow, UK
  1. Correspondence to Mauro Laudicella; Mauro.Laudicella.1{at}


Objective Laparoscopy is increasingly being used as an alternative to open surgery in the treatment of patients with colon cancer. The study objective is to estimate the difference in hospital costs between laparoscopic and open colon cancer surgery.

Design Population-based retrospective cohort study.

Settings All acute hospitals of the National Health System in England.

Population A total of 55 358 patients aged 30 and over with a primary diagnosis of colon cancer admitted for planned (elective) open or laparoscopic major resection between April 2006 and March 2013.

Primary outcomes Inpatient hospital costs during index admission and after 30 and 90 days following the index admission.

Results Propensity score matching was used to create comparable exposed and control groups. The hospital cost of an index admission was estimated to be £1933 (95% CI 1834 to 2027; p<0.01) lower among patients who underwent laparoscopic resection. After including the first unplanned readmission following index admission, laparoscopy was £2107 (95% CI 2000 to 2215; p<0.01) less expensive at 30 days and £2202 (95% CI 2092 to 2316; p<0.01) less expensive at 90 days. The difference in cost was explained by shorter hospital stay and lower readmission rates in patients undergoing minimal access surgery. The use of laparoscopic colon cancer surgery increased 4-fold between 2006 and 2012 resulting in a total cost saving in excess of £29.3 million for the National Health Service (NHS).

Conclusions Laparoscopy is associated with lower hospital costs than open surgery in elective patients with colon cancer suitable for both interventions.

  • Hospital Costs

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  • Contributors ML, BW, AM and OF were involved in formulating the study hypothesis. ML had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. ML carried out the empirical analysis. ML, BW and AM prepared the first study draft; all authors contributed and approved the final version submitted.

  • Funding The work is supported by a Macmillan Cancer Support Grant (ML, BW), Cancer Research UK and the National Institute for Health Research (AM), and the St Mark's Foundation (OF).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of Macmillan, Cancer Research UK, St Marks, the NHS, the NIHR, or the Department of Health.

  • Competing interests None declared.

  • Ethics approval The authors had approval from the Ethics Committee of the School of Health Sciences of City, University of London to conduct the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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