Impact of laparoscopic versus open surgery on hospital costs for colon cancer: a population-based retrospective cohort study

Mauro Laudicella, Brendan Walsh, Aruna Munasinghe, Omar Faiz

Research output: Contribution to journalJournal articleResearchpeer-review


OBJECTIVE: Laparoscopy is increasingly being used as an alternative to open surgery in the treatment of patients with colon cancer. The study objective is to estimate the difference in hospital costs between laparoscopic and open colon cancer surgery.

DESIGN: Population-based retrospective cohort study.

SETTINGS: All acute hospitals of the National Health System in England.

POPULATION: A total of 55 358 patients aged 30 and over with a primary diagnosis of colon cancer admitted for planned (elective) open or laparoscopic major resection between April 2006 and March 2013.

PRIMARY OUTCOMES: Inpatient hospital costs during index admission and after 30 and 90 days following the index admission.

RESULTS: Propensity score matching was used to create comparable exposed and control groups. The hospital cost of an index admission was estimated to be £1933 (95% CI 1834 to 2027; p<0.01) lower among patients who underwent laparoscopic resection. After including the first unplanned readmission following index admission, laparoscopy was £2107 (95% CI 2000 to 2215; p<0.01) less expensive at 30 days and £2202 (95% CI 2092 to 2316; p<0.01) less expensive at 90 days. The difference in cost was explained by shorter hospital stay and lower readmission rates in patients undergoing minimal access surgery. The use of laparoscopic colon cancer surgery increased 4-fold between 2006 and 2012 resulting in a total cost saving in excess of £29.3 million for the National Health Service (NHS).

CONCLUSIONS: Laparoscopy is associated with lower hospital costs than open surgery in elective patients with colon cancer suitable for both interventions.

Original languageEnglish
JournalBMJ Open
Issue number11
Pages (from-to)e012977
Publication statusPublished - 3. Nov 2016
Externally publishedYes

Bibliographical note

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to


  • Adult
  • Aged
  • Aged, 80 and over
  • Colectomy/economics
  • Colonic Neoplasms/economics
  • Elective Surgical Procedures
  • England
  • Female
  • Hospital Costs
  • Hospitalization/economics
  • Hospitals
  • Humans
  • Laparoscopy/economics
  • Length of Stay/economics
  • Male
  • Middle Aged
  • Patient Readmission/economics
  • Propensity Score
  • Retrospective Studies


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