A Financial Analysis of Pediatric Laparoscopic Versus Open Fundoplication

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Abstract
Introduction: Laparoscopic fundoplication (LF) is rapidly replacing open fundoplication (OF) for correcting symptomatic gastroesophageal reflux (GER) in infants and children. In this study, we compared various clinical and financial parameters to determine if one technique is superior. Methods: With Institutional Review Board approval, charts and charge data for 50 consecutive patients undergoing elective LF or OF were reviewed in 2003 and 2004 (n = 100). Clinical variables evaluated included gender, age, weight, length of stay (LOS), operating time (OT), and time to initial (IF) and full (FF) feedings. Financial charges that were reviewed included anesthesia, central supply and sterilization, equipment, operating suite, hospital room and board, pharmacy, and total charges. Results: The groups were equally matched in relation to gender, age, and weight. The table below illustrates the statistically significant differences (P < 0.05) between the groups. Favoring LNF LOS (1.2 vs. 2.9 days) IF (7.3 vs. 27.9 hours) FF (21.8 vs. 42.9 hours) Equipment ($1,006 vs. $1,609) Hospital Room ($1,290 vs. $2,847) Pharmacy ($180 vs. $461) Favoring OF OT (77 vs. 91 minutes) Anesthesia ($389 vs. $475) Central Supply and Sterilization ($1,367 vs. $2,515) Operating Suite ($4,058 vs. $5,142) Total charges were similar (LF, $11,449; OF, $11,632). Conclusions: Interestingly, although there were statistical differences in every charge category, total charges for LF and OF did not differ significantly. Thus, traditionally higher expenses from longer OT for LF seem to be offset by financial benefits, such as shorter LOS, reduced discomfort as evidenced by lower narcotic charges, and earlier IF/FF.