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JAMA Surg. 2013 Jul;148(7):641-7. doi: 10.1001/jamasurg.2013.131.

Impact of minimally invasive surgery on medical spending and employee absenteeism.

Author information

1
Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, US Department of Veterans Affairs, Philadelphia, Pennsylvania, USA. eandrew@mail.med.upenn

Abstract

IMPORTANCE:

As many surgical procedures have undergone a transition from a standard, open surgical approach to a minimally invasive one in the past 2 decades, the diffusion of minimally invasive surgery may have had sizeable but overlooked effects on medical expenditures and worker productivity.

OBJECTIVE:

To examine the impact of standard vs minimally invasive surgery on health plan spending and workplace absenteeism for 6 types of surgery.

DESIGN:

Cross-sectional regression analysis.

SETTING:

National health insurance claims data and matched workplace absenteeism data from January 1, 2000, to December 31, 2009.

PARTICIPANTS:

A convenience sample of adults with employer-sponsored health insurance who underwent either standard or minimally invasive surgery for coronary revascularization, uterine fibroid resection, prostatectomy, peripheral revascularization, carotid revascularization, or aortic aneurysm repair.

MAIN OUTCOMES AND MEASURE:

Health plan spending and workplace absenteeism from 14 days before through 352 days after the index surgery.

RESULTS:

There were 321,956 patients who underwent surgery; 23,814 were employees with workplace absenteeism data. After multivariable adjustment, mean health plan spending was lower for minimally invasive surgery for coronary revascularization (-$30,850; 95% CI, -$31,629 to -$30,091), uterine fibroid resection (-$1509; 95% CI, -$1754 to -$1280), and peripheral revascularization (-$12,031; 95% CI, -$15,552 to -$8717) and higher for prostatectomy ($1350; 95% CI, $611 to $2212) and carotid revascularization ($4900; 95% CI, $1772 to $8370). Undergoing minimally invasive surgery was associated with missing significantly fewer days of work for coronary revascularization (mean difference, -37.7 days; 95% CI, -41.1 to -34.3), uterine fibroid resection (mean difference, -11.7 days; 95% CI, -14.0 to -9.4), prostatectomy (mean difference, -9.0 days; 95% CI, -14.2 to -3.7), and peripheral revascularization (mean difference, -16.6 days; 95% CI, -28.0 to -5.2).

CONCLUSIONS AND RELEVANCE:

For 3 of 6 types of surgery studied, minimally invasive procedures were associated with significantly lower health plan spending than standard surgery. For 4 types of surgery, minimally invasive procedures were consistently associated with significantly fewer days of absence from work.

PMID:
23552709
DOI:
10.1001/jamasurg.2013.131
[Indexed for MEDLINE]

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