COST-ANALYSIS OF DIAGNOSTIC LAPAROSCOPY VS LAPAROTOMY IN THE EVALUATION OF PENETRATING ABDOMINAL-TRAUMA

Background: Diagnostic laparoscopy for the evaluation of injuries in p atients with penetrating abdominal trauma has been shown to decrease t he morbidity and mortality associated with mandatory laparotomy. The o verall impact on patient care and hospital costs has not been thorough ly investigated. The goal of this study was to determine the economic impact of laparoscopy as a diagnostic tool in the management of patien ts following penetrating trauma to the abdomen or flank. Methods: Retr ospective chart review of all hemodynamically stable patients with pen etrating trauma to the abdomen or flank, but without other injuries re quiring emergent intervention, admitted to a level I trauma center bet ween January 1, 1992, and September 30, 1994. Those patients who under went either laparoscopy (DL) or laparotomy (NL) or both (CONV) and who had no intraabdominal organ injuries requiring surgical therapeutic i ntervention were included in the study. Age, operative time, operative findings, length of hospitalization, Injury Severity Score (ISS), var iable costs, and total costs were recorded for each patient. Results: Fourteen patients underwent negative/nontherapeutic laparoscopy (DL), 19 patients underwent negative/nontherapeutic laparotomy (NL), and fou r patients underwent both laparoscopy and laparotomy, a conversion pro cedure (CONV). There was no significant difference in age, operative t imes, or ISS between the DL and NL groups. Mean ISS of CONV patients w as significantly greater than that of DL patients, 5.75 +/- 1.97 vs 2. 43 +/- 0.63 (p < 0.05). Mean operative time for CONV patients was also significantly greater than both DL and NL patients, 106.5 +/- 17.00 m in vs 66.1 +/- 6.55 and 47.3 +/- 7.50 min, respectively (p < 0.05). Th e mean length of stay was significantly shorter in the DL group as com pared to the NL or CONV groups, 1.43 +/- 0.20 vs 4.26 +/- 0.31 and 5.0 +/- 0.82 (p < 0.0001). The variable costs for the DL group were signi ficantly lower than those incurred by patients in the NL and CONV grou ps, $2,917 +/- 175 vs $3,384 +/- 102 and $3,774 +/- 286, (p < 0.05). V ariable costs were not significantly different between the NL and CONV groups. Total costs were also significantly lower in the DL group whe n compared to NL and CONV, $5,427 +/- 394 vs $7,026 +/- 251 and $7,855 +/- 750 (p < 0.005), but again, they were not statistically different between the NL and CONV groups. The overall total costs for laparosco py, including the casts incurred by conversion patients, was significa ntly less than the total costs for laparotomy patients, $5,664 +/- 394 vs $7,028.47 +/- 250 (p < 0.005). This resulted in an overall savings of $1,059.44 per laparoscopy performed. The overall negative/nonthera peutic laparotomy rate during this study was 19.1%, which was signific antly lower than the negative or nontherapeutic exploration rate durin g the time period prior to the use of laparoscopy (p < 0.01, z = 2.550 ). Conclusion: Variable and total costs and length of stay were signif icantly lower in our population of patients who underwent DL as compar ed to NL. The rate of negative or nontherapeutic laparotomy was also s ignificantly reduced when compared to the rate identified during the e ra prior to the use of laparoscopy. Laparoscopy resulted in an overall savings of $1,059 per laparoscopy performed when compared to laparoto my.