TITLE

Minimally invasive: minimally reimbursed? An examination of six laparoscopic surgical procedures

AUTHOR(S)
Roumm, Adam R.; Pizzi, Laura; Goldfarb, Neil I.; Cohn, Herbert
PUB. DATE
September 2005
SOURCE
Surgical Innovation;Sep2005, Vol. 12 Issue 3, p261
SOURCE TYPE
Academic Journal
DOC. TYPE
journal article
ABSTRACT
It is generally believed that minimally invasive surgery (MIS) results in less postoperative pain, fewer complications, and shorter recovery periods compared with open procedures. Yet despite these benefits, the level of reimbursement assigned to the surgeon by United States health-care payers is often lower than that for open procedures. Furthermore, the cost of performing a MIS may be higher vs an open procedure because specialized equipment, increased surgical time, or both may be required. In this report, we examine the issue by comparing reimbursements for MIS with open procedures, summarizing the medical literature on MIS vs open surgical procedures, and offering recommendations for payers who establish reimbursement policies. The review is focused on six MIS procedures where outcomes data exist: laparoscopic cholecystectomy (lap chole), laparoscopic colectomy (LC), laparoscopic fundoplication (LF), laparoscopic hysterectomy (LH), laparoscopic ventral hernia repair (LVHR), and laparoscopic appendectomy (LA). Outcomes summarized were length of hospital stay (LOS), operating room time, operating room costs, complications, and return to work or normal activities. The level of scientific evidence was assigned to each study using predetermined criteria. A total of 112 articles were reviewed: 14 for lap chole, 26 for LC, 7 for LF, 19 for LH, 9 for LVHR, and 37 for LA. The data demonstrate that these procedures result in reduced hospital stay, reduced hospital costs, and faster return to work or normal activities. Yet, the operating room time and costs are frequently higher for MIS. These findings suggest that as both the outcomes value and level of operating room resources are greater, MIS warrants reimbursement that meets or exceeds that of open procedures.
ACCESSION #
18643921

 

Related Articles

  • Incisional Hernia Rate May Increase After Single-Port Cholecystectomy. Alptekin, Husnu; Yilmaz, Huseyin; Acar, Fahrettin; Kafali, M. Ertugrul; Sahin, Mustafa // Journal of Laparoendoscopic & Advanced Surgical Techniques;Oct2012, Vol. 22 Issue 8, p731 

    Background: The major concerns of single-port cholecystectomy are port-site hernia and cost. Essentially, a larger transumbilical incision is more likely to increase the incidence of incisional hernia. The effect of single-port cholecystectomy on hospital cost is controversial. This study...

  • A cost–utility analysis of treatment options for inguinal hernia in 1,513,008 adult patients. Stylopoulos, N.; Gazelle, G.S.; Rattner, D.W. // Surgical Endoscopy;Feb2003, Vol. 17 Issue 2, p180 

    Background: The controversial issue of the cost-effectiveness of laparoscopic inguinal hernia repair is examined, employing a decision analytic method. Materials and methods: The NSAS, NHDS (National Center for Health Statistics), HCUP-NIS (Agency for Healthcare Research and Quality) databases...

  • Laparoscopic abdominal surgery. Perrin, Mandy; Fletcher, Anthony // Continuing Education in Anaesthesia, Critical Care & Pain;Aug2004, Vol. 4 Issue 4, p107 

    Laparoscopic surgery is now widely established. Benefits include reduced postoperative pain, improved cosmetic results and patient satisfaction, and reduced hospital stays. The range of surgical techniques is increasing in complexity and now includes cholecystectomy, adrenalectomy, nephrectomy,...

  • Incisional hernia after upper abdominal surgery: a randomised controlled trial of midline versus transverse incision. Halm, J. A.; Lip, H.; Schmitz, P. I.; Jeekel, J. // Hernia;Jun2009, Vol. 13 Issue 3, p275 

    To determine whether a transverse incision is an alternative to a midline incision in terms of incisional hernia incidence, surgical site infection, postoperative pain, hospital stay and cosmetics in cholecystectomy. Incisional hernias after midline incision are commonly underestimated but...

  • Randomized controlled study of laparoscopic total extraperitoneal versus open lichtenstein inguinal hernia repair. Lal, Pawanindra; Kajla, R.K.; Chander, J.; Saha, R.; Ramteke, V.K. // Surgical Endoscopy;Jun2003, Vol. 17 Issue 6, p850 

    Background: Whereas open anterior inguinal herniorrhaphy is a time-tested, safe, and well-understood operation with a high success rate, laparoscopic techniques of inguinal hernia repair are fairly recent. Consequently, short- and long-term outcomes are still being evaluated. Few studies have...

  • SINGLE ACCESS LAPAROSCOPIC SURGERY FOR BASIC SURGICAL PROCEDURES: IS ALL THAT GLITTERS GOLD? Bracale, Umberto; Andreuccetti, Jacopo; Merola, Giovanni; Lazzara, Fabrizio; Pignata, Giusto // BH Surgery;2013, Vol. 3 Issue 1, p6 

    The trend of recent years is to reduce the parietal trauma ensuring scarless surgery as the wound is hidden within the umbilicus. Single Access Laparoscopic Surgery (SALS) describe this type of surgery with single trans-umbilical laparoscopic access. We report the international evidence and our...

  • Appendektomia laparoskopowa metodÄ… SILS przy użyciu systemu Tri-Port -- pierwsze polskie doniesienie. Nitkowski, Paweł; Proczka, Robert Michał; Polański, Jerzy // Polish Surgery / Chirurgia Polska;2009, Vol. 11 Issue 2, p61 

    Background: Laparoscopic appendectomy is one of the most commonly performed laparoscopic procedures. It is most often performed utilizing three access ports. Since 2008 we have noticed the rapid development of a new surgical method - single incision laparoscopic surgery (SILS). SILS offers...

  • Laparoscopic Surgery—15 Years After Clinical Introduction. Bittner, Reinhard // World Journal of Surgery;Jul2006, Vol. 30 Issue 7, p1190 

    The article reflects on the development of laparoscopic surgery. The author agreed in the contribution of laparoscopic surgery in enhancing surgical techniques thus providing patient who undergone the operation with less complications and shorter hospitalization but criticizes the expensiveness...

  • Low risk of trocar site hernia repair 12 years after primary laparoscopic surgery. Helgstrand, Frederik; Rosenberg, Jacob; Kehlet, Henrik; Bisgaard, Thue // Surgical Endoscopy;Nov2011, Vol. 25 Issue 11, p3678 

    Background: The risk of trocar site hernia (TSH) may be 0-22%, but no large scaled data with long-term follow-up are available. The purpose of this study was to estimate the long-term risk of TSH repair. Methods: All patients in Denmark who underwent a laparoscopic procedure in 1997 were...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics