Minimally invasive surgery lowers healthcare costs

As healthcare costs continue to rise, the U.S. continues to search for ways to provide affordable coverage to all citizens. The Affordable Care Act, Medicare and Medicaid are modern players in the long fight against increasing healthcare costs. However, a new quantitative study may soon change the way we think of hospital costs. The healthcare industry in the U.S., made up of physicians, hospitals and insurance providers, represents a $3.8 trillion dollar industry, according to Forbes. Yet, a McKinsey Study showed that the United States, while spending more on healthcare per capita than any other developed country, does not enjoy higher health outcome measures such as percent obesity and life expectancy. Many theories exist regarding this paradox: the higher cost of medical procedures, an overly bureaucratic administration, increased length of inpatient stay and even a lack of preventative medicine. However, whatever the reason may be, it is clear that a systematic cost reduction is critically needed. Minimally invasive surgery has flourished in the current age of technology-based medicine. Through innovations in biomedical engineering, physicians can perform what were once open surgeries with minimally invasive tools such as laparoscopic devices and robotically controlled instruments. The Mayo Clinic reports that because patients often have just a very small incision, there is lesser chance of painful and life-threatening postoperative infections. Recovery times also increase because less healthy tissue is damaged during the procedure. Surgical procedures represent a substantial single contributor to aggregate healthcare expenses. A new study led a professor of surgery at the Hopkins School of Medicine, Marty Makary, and published in The Journal of the American Medical Association (JAMA) Surgery, took a quantitative approach to surgical costs by studying the cost savings and number of postoperative complications avoided by performing minimally invasive surgery versus open surgery. Makary said in the report that minimally invasive surgery is an often-overlooked opportunity to make surgery safer and less costly. For their study, the researchers used the 2010 National Inpatient Sample for patients undergoing an appendectomy (the removal of the appendix), a partial colectomy (removal of part of the colon) or a lung lobectomy (removal of part of the lung). In order to limit the effect of confounding variables, Makary removed instances of emergency surgery and high-risk patients. From this dataset, Markary and his team were able to observe open and minimally invasive surgeries (MIS) with and without postoperative complications. In order to study the cost of postoperative complications associated with open surgery, the researchers considered seven postoperative complications listed in the Agency for Healthcare Research and Quality’s Patient Safety Indicators. The team first built a two-stage regression model for excess cost in cases with and without postoperative complications. From their model, Markary was able to create two simulations in which patients with open surgery instead underwent minimally invasive surgery and from there compute the cost savings, number of complications avoided and number of hospital days avoided. In the first simulation, hospitals that were performing a low number of MIS (i.e., up to the 83rd percentile of hospitals) performed as many MIS as the 83rd percentile. In the second scenario, all hospitals increased their number MIS by 50 percent from the baseline. The investigators found that there was a marked decrease in surgical costs, postoperative complications and hospital stays in both simulations. If hospitals increased their rate of MIS to that of the 83rd percentile, patients could have 169,819 fewer days in the hospital and 4,306 fewer postoperative complications. In total, this would mean a $377 million reduction in annual cost. As Makary concludes, the team’s results indicate that MIS is underutilized and should be a choice given to patients more often. While not applicable in all cases, lower cost, less harmful minimally invasive surgeries may be an effective solution to reducing the fiscal burden of healthcare while also improving patient satisfaction.