Money well spent: A comparison of hospital operating margin for laparoscopic and open colectomies

Background: Cost analysis after laparoscopic colectomy has been examined, although reports evaluating the effects of laparoscopy on hospital operating margin are lacking. We compared several cost/revenue measures, including hospital operating margin, between open and laparoscopic colectomies at an academic center. Methods: Our cost-accounting database was queried for laparoscopic partial (LPC) and total colectomies (LTC), and open partial (OPC) and total colectomies (OTC) to analyze net revenue, total costs, and total hospital operating margin over a 4-year period. Laparoscopic and open colectomy cases were compared, with mean operating margin as the primary outcome. Results: From July, 2002 through May, 2006, 842 patients were included for analysis with 138 undergoing laparoscopic colectomy. Net revenue was higher in the LTC group compared with open ($30,300 vs $26,800 [P = .02]), and lower in the LPC group ($15,300 vs $21,300 open [P < .0001]). Total costs were reduced in both the LPC and LTC groups compared with open [$11,700 vs $17,600 [P < .0001] and $18,000 vs $19,400 [P = .0019], respectively). LPC resulted in a similar HOM ($3,602) compared with OPC ($3,647; P = .35). LTC resulted in a higher HOM ($12,300) compared with OTC ($7,400; P = .02). Conclusions: LTC generates a significantly higher hospital operating margin than an OTC, although the margins are similar for LPC and OPC.