Evaluation of the cost for laparoscopic-assisted Billroth I gastrectomy

Background: Despite the rapid spread of laparoscopic gastric surgery in Japan, no one has yet evaluated the costs for this new technique. The aim of this study was to analyze and compare the hospital charges for laparoscopic-assisted gastrectomy with those for conventional open gastrectomy. Methods: The study included 48 consecutive patients who underwent laparoscopic-assisted Billroth I gastrectomy and 43 who had a conventional open Billroth I gastrectomy for cure of early gastric cancer between May 1994 and April 2000. Hospital charges covered all costs incurred during the hospital stay; they were divided into charges for consultation, prescription, injection, nursing care, operating theater, laboratory, radiology, ward and meal, and others. Results: The patients who underwent laparoscopic gastrectomy were similar to those who had open gastrectomy in terms of symptoms, concurrent illness, operation time, proximal resection margin, number of harvested lymph nodes. and stage of the disease. Hospital stay after laparoscopic gastrectomy was shorter than that after open gastrectomy (16.1 vs 20.5 days, p < 0.01). Charges for nursing care, charges for ward and meal. and total hospital charges were less in the laparoscopic group than in the open roup (Y5800 vs Y8010, p < 0.01; Y461 x 10(3) vs Y512 x 10(3), p < 0.05; Y1336 x 10(3) vs Y1411 x 10(3), p = 0.072). When we compared laparoscopic gastrectomies performed during 1994-96 with those done during 1997-2000, we found a decrease in charges for ward and meal and total hospital charges (Y498 x 10(3) vs Y421 x 10(3), P < 0.01; Y1390 x 10(3) vs Y1277 x 10(3), P < 0.01). Conclusion: Laparoscopic-assisted Billroth I gastrectomy is less expensive than conventional open Billroth I gastrectomy because both the postoperative recovery period and the hospital stay are shorter. In patients who undergo gastrectomy, the additional costs of the disposable instruments can be fully offset by the lower charges for ward and meal and nursing care associated with laparoscopic gastrectomy.