Cost Analysis of Laparoscopic and Open Fundoplication in Children

Abstract

ABSTRACT

Laparoscopy has been successfully applied to the treatment of gastroesophageal reflux disease in children. Initial series demonstrate equivalent early outcomes for laparoscopic and open techniques of fundoplication. Increased operative times, expensive equipment, and non-contemporary comparison samples have made financial benefits for the laparoscopic techniques difficult to realize. This study compares the cost and early outcome for 59 consecutive primary fundoplications (25 laparoscopic, 34 open) performed at the same children's hospital between January 1,1995 and September 30,1995. Prospective database entries, hospital medical records, and telephone interviews were used to assess demographics, operating room time, associated procedures, time until full feeding and discharge, complications, financial data, and degree of clinical success for each case. The two groups were similar demographically and had equivalent early outcomes. One laparoscopic case was converted to the open technique. Operating room (OR) time was 25 min longer in the laparoscopic group (167 min vs. 142 minutes,p = 0.005), corresponding to a $375 higher OR charge in this group ($3,223 vs. $2,848). There was no statistical difference in postoperative hospital stay (5 vs. 4 days) or combined OR and postoperative charges ($9,643 vs. $12,173) (p = 0.46 and p = 0.66, respectively, for stay and cost). Laparoscopic group complications included two gastrostomy leaks and one patient with persistent dysphagia requiring dilation. The open group complications included four wound infections and one small bowel obstruction. Laparoscopic fundoplication can achieve clinical results equivalent to open techniques and may be more cost effective in selected pediatric subgroups.