Mar 20, 2013

Less-Invasive Surgery Tied to Lower Costs, Less Absenteeism

Minimally-invasive forms of heart surgery and fibroid removal may be less expensive – and cause patients to take fewer days off from work – than standard versions of the same procedures, a new study suggests.

Researchers looking at six common surgeries found that if every one of them done in the U.S. in 2009 had used minimally-invasive techniques, health plans would have saved $2.3 billion and employees would have missed about 20,000 fewer days of work.

The researchers pointed out, however, that not all surgeries can be done with smaller incisions. And they didn’t have data on how patients fared after standard versus less-invasive procedures.

“We’re not saying everyone should get minimally-invasive surgery,” said Andrew Epstein, who led the study at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia.

“What we are saying, I think, is that at least for these procedures, we’ve demonstrated there’s this other dimension of potential value associated with minimally-invasive procedures,” he told Reuters Health.

Epstein and his colleagues analyzed insurance claims from 322,000 young and middle-aged adults undergoing one of six surgeries in 2001 through 2008: coronary revascularization, uterine fibroid resection, prostatectomy, peripheral revascularization, carotid revascularization, or aortic aneurysm repair.

About 60% of surgeries were done using minimally-invasive techniques. After multivariable adjustment, mean health plan spending was lower for minimally invasive surgery for coronary revascularization (by $30,850), uterine fibroid resection (by $1509), and peripheral revascularization (by $12,031) and higher for prostatectomy (by $1350) and carotid revascularization (by $4900).

Among 24,000 employees with absenteeism data who had surgery, four of the six procedures led to an average of between nine and 38 fewer missed days of work than traditional options, the researchers reported Wednesday in JAMA Surgery.

Those findings held after adjustment for patients’ age, gender and general health.

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“I don’t think the results are shocking, at least in the sense of showing that people with minimally-invasive procedures miss less work,” Epstein said. That’s consistent with research showing patients have shorter hospital stays following less-invasive procedures, he added.

“From a patient’s perspective, whenever you undergo a surgery, you want to get back to your normal life and normal function as fast as you can,” said Dr. Jason Wright, a gynecologic surgeon at Columbia University Medical Center in New York.

Still, he added, there’s a need for more research on the long-term outcomes of many types of minimally-invasive surgery. And those outcomes may not look the same for every person.

“Each one of these really needs to be individualized,” he said. “Patients really need to be aware of their options.”


JAMA Surgery 2013.


— Genevra Pittman


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