Increasing use of minimally invasive surgery 'would avert thousands of post-op complications'

A new study conducted by researchers from Johns Hopkins Medicine claims that health care costs and the number of postoperative complications across the USA could be significantly reduced if hospitals were to increase their use of minimally invasive surgery for some common procedures.

The team estimates that if all hospitals in the US were to increase their use of minimally invasive surgery by 50%, 3,578 postoperative complications would be avoided each year.

Researchers at the Johns Hopkins University School of Medicine published their findings in the journal JAMA Surgery.

An alternative to conventional open surgery, minimally invasive surgery - also referred to as laparoscopic surgery or keyhole surgery - involves accessing organs through small surgical incisions in order to operate on them.

According to the American Institute of Minimally Invasive Surgery (AIMIS), such procedures result in fewer stitches, less pain and scarring, faster recovery and shorter hospital stays, compared with open surgery.

For their study, the researchers set out to assess whether increased use of minimally invasive surgery in the USA for some commonly performed procedures would reduce patients' risk of complications following surgery, as well associated health care costs.

The team assessed data from the National Inpatient Sample Database, which provided information on postoperative complications and health care costs for more than 80,000 patients who underwent one of seven common surgeries, including lung, appendix and colon surgery.

These surgeries were chosen for analysis because both open surgery and minimally invasive surgery are deemed standard care for them, the researchers explain.

Findings suggest minimally invasive surgery is 'grossly underutilized'

The researchers note that not all patients are eligible for minimally invasive surgery. 

However, among similar patients in similar hospitals who were candidates for the procedure, they identified large variations in its use.

If the hospitals that performed the fewest minimally invasive surgeries increased their levels to those of the hospitals that performed the most minimally invasive procedures, the team calculated that 4,306 postoperative complications could be avoided, $337 million in health care costs could be saved, and hospitals stays could be reduced by 169,819 days each year.

In addition, the team estimates that if all hospitals in the USA were to increase their use of minimally invasive surgery by 50%, 3,578 postoperative complications would be avoided, health care costs would be cut by $288 million, and hospital stays would be reduced by 144,863 days each year.

"The decision to perform an open versus minimally invasive procedure should be made according to each patient's specific case and overall health, among other factors. But our results make a very strong case that minimally invasive surgery is grossly underutilized and, at a minimum, ought to be offered to patients more often."

The researchers conclude that hospitals should focus on increasing their use of minimally invasive surgery where appropriate. What is more, they say hospitals should think about retraining surgeons and consider a "division of labor," in which patients who need open surgery are operated on by surgeons who are skilled in the procedure, while patients who require minimally invasive surgery are operated on by surgeons who have expertise in that area.

Minimally invasive surgery, done in the right patients, represents an under-recognized opportunity not only for cost savings, but also for making surgery safer, reducing the very real suffering associated with surgical complications.

References:

1.  Hospital cost implications of increased use of minimally invasive surgery, Marty Makary, et al., JAMA Surgery, published online 25 March 2015.
2.  Johns Hopkins Medicine news release, accessed 24 March 2015 via Newswise.
3.  Additional source: AIMIS, What is minimally invasive surgery?, accessed 24 March 2015.