Why ‘Keyhole’ Surgery Should Be More Common

April 2, 2015 Updated: April 5, 2015

Minimally invasive surgeries are not performed often enough, resulting in unnecessary complications from traditional open incision procedures and costing U.S. hospitals upward of $280 million a year.

The findings are based on a new analysis that compares outcomes from routine open and minimally invasive appendix, colon, and lung operations.

“Minimally invasive surgery, done in the right patients, represents an under-recognized opportunity not only for cost savings, but also for making surgery safer, reducing the very real suffering associated with surgical complications,” said lead investigator Marty Makary, professor of surgery at Johns Hopkins University.

Tiny ‘Keyholes’

Minimally invasive surgery, also known as laparoscopic surgery, involves making tiny incisions, or “keyholes,” to access organs and operate on them, in contrast with cutting into and through much larger areas of tissue.

“The decision to perform an open versus minimally invasive procedure should be made according to each patient’s specific case and overall health, among other factors,” Makary said.

“But our results make a very strong case that minimally invasive surgery is grossly underutilized and, at a minimum, ought to be offered to patients more often,” he said.

For the study, published in JAMA Surgery, researchers analyzed more than 80,000 cases from the National Inpatient Sample database, tracking seven common post-surgical complications and associated billing charges.

Less Cost, Fewer Complications

They focused on appendix, colon, and lung cases because both the open and minimally invasive approaches are considered standard for those surgeries.

While not all patients are candidates for minimally invasive treatment, the study reveals great variation in its use among similar patients who would qualify and who were treated at similar hospitals.

To calculate the cost difference between open and minimally invasive surgery, the investigators compared the actual cost for each patient who underwent traditional surgery against the estimated cost for the same patient undergoing minimally invasive treatment.

In addition, the investigators calculated potential cost savings under two hypothetical scenarios: when all hospitals increased their use of minimally invasive surgery by 50 percent and when the hospitals performing the fewest such procedures, the so-called low utilizers, upped them to the level of hospitals performing in the upper one-third.

The tally shows that if all U.S. hospitals increased the number of minimally invasive procedures by 50 percent, they would avert 3,578 complications, reduce hospital stay by 144,863 days, and save $288 million a year.

If hospitals performing the fewest minimally invasive operations boosted their levels to those of their higher-performing counterparts, the collective savings would be $337 million a year, 4,306 fewer complications, and 169,819 fewer hospital days.

Hospital leaders should increase capacity for minimally invasive treatment and streamline division of labor so that surgeons with expertise in minimally invasive treatment can operate on patients who qualify, the researchers said.

Republished from Futurity.org under Creative Commons License 4.0.

*Image of “arm” via Phalinn Ooi/Flickr