Comparison of health-care utilization and expenditures for minimally invasive vs. open colectomy for benign disease.

BACKGROUND: Adoption of minimally invasive approaches continues to increase, and there is a need to reassess outcomes and cost. We aimed to compare open versus minimally invasive colectomy short- and long-term health-care utilization and payer/patient expenditures for benign disease. METHODS: This is a retrospective analysis of IBM® MarketScan® Database patients who underwent left or right colectomy for benign disease between 2013 and 2018. Outcomes included total health-care expenditures, resource utilization, and direct workdays lost up to 365 days following colectomy. The open surgical approach (OS) was compared to minimally invasive colectomy (MIS) with subgroup analysis of laparoscopic (LS) and robotic (RS) approaches using inverse probability of treatment weighting. RESULTS: Of 10,439 patients, 2531 (24.3%) had open, 6826 (65.4%) had laparoscopic, and 1082 (10.3%) had robotic colectomy. MIS patients had shorter length of stay (LOS; mean difference, - 1.71, p < 0.001) and lower average total expenditures (mean difference, - $2378, p < 0.001) compared with open patients during the index hospitalization. At 1 year, MIS patients had lower readmission rates, and fewer mean emergency and outpatient department visits than open patients, translating into additional savings of $5759 and 2.22 fewer days missed from work for health-care visits over the 365-day post-discharge period. Within MIS, RS patients had shorter LOS (mean difference, - 0.60, p < 0.001) and lower conversion-to-open rates (odds ratio, 0.31 p < 0.001) during the index hospitalization, and lower hospital outpatient visits (mean difference, - 0.31, p = 0.001) at 365 days than LS. CONCLUSION: MIS colectomy is associated with lower mean health-care expenditures and less resource utilization compared to the open approach for benign disease at index operation and 365-days post-discharge. Health-care expenditures for LS and RS are similar but shorter mean LOS and lower conversion-to-open surgery rates were observed at index operation for the RS approach.

Hospital opioid use predicts the need for discharge opioid prescriptions following laparoscopic bariatric surgery.

BACKGROUND: Overprescribing of opioids after surgery increases new persistent opioid use and diversion contributing to the opioid epidemic. There is a paucity of evidence regarding discharge opioid prescribing after bariatric surgery. METHODS: We conducted a retrospective, cohort study analyzing post-operative opioid use at a single institution in patients who underwent laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LGB) from July 2019 thru February 2020. Multimodal analgesia was used including 5 mg oxycodone pills as needed during hospitalization with five prescribed on discharge if requested after discussion. Opioid use was determined from medical record review and post-operative data collected from patients at a 2-week follow-up visit. The Michigan Automated Prescription System (MAPS) was used as an adjunct to evaluate perioperative opioid prescriptions. RESULTS: The cohort of 84 patients included those having LSG (72) and LGB (12). Fifty-five patients (65%) received a prescription for opioids on discharge and 91% filled their prescription. Only 44% (22/50) of those filling their opioid prescription took any opioids with 24% (65/275) of the total pills prescribed actually consumed. Opioid use on the surgical ward had the strongest correlation with discharge opioid use (rho = 0.65, CI 0.494, 0.770). The number of opioid pills taken on the surgical ward was positively associated with the number of pills taken after discharge. Those who took none, 1 to 3, or 4 or more opioid pills consumed 0.14 ± 0.48, 0.95 ± 1.71, and 3.14 ± 1.86 pills after discharge (p < 0.001). No patients required an additional opioid prescription within 90 days of surgery with MAPS confirmation. CONCLUSION: Postoperative in-hospital opioid use following laparoscopic bariatric surgery predicts opioid use after discharge. This knowledge can guide patient-specific discharge opioid prescribing with the potential to mitigate diversion and reduce chronic opioid use.