Evidence map›Paper›PMID 29484556›Full record

ArticleSurgical endoscopy2018

Minimally invasive versus open surgery in the Medicare population: a comparison of post-operative and economic outcomes.

Caleb J Fan, Hung-Lun Chien, Matthew J Weiss, Jin He, Christopher L Wolfgang, John L Cameron, Timothy M Pawlik, Martin A Makary

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in Surgical endoscopy, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Trial
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  9. Observational
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  14. Laparoscopic versus open ventral hernia repair in the elderly: a propensity score-matched analysis.Hernia : the journal of hernias and abdominal wall surgery · 2021
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  15. Review
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  18. Impact of Liver Cirrhosis on Perioperative Outcomes Among Elderly Patients Undergoing Hepatectomy: the Effect of Minimally Invasive Surgery.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2019
    Article
  19. Article
  20. A Comparison of Open and Minimally Invasive Surgery for Hepatic and Pancreatic Resections Among the Medicare Population.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2018
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Caleb J FanDepartment of Otolaryngology, Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. caleb.fan@mountsinai.org.
Hung-Lun ChienMinimally Invasive Therapies Group, Medtronic Inc., Mansfield, MA, USA.
Matthew J WeissDepartment of Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Jin HeDepartment of Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Christopher L WolfgangDepartment of Surgery, The Johns Hopkins University, Baltimore, MD, USA.
John L CameronDepartment of Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Timothy M PawlikDepartment of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Martin A MakaryDepartment of Surgery, The Johns Hopkins University, Baltimore, MD, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDespite strong evidence demonstrating the clinical and economic benefits of minimally invasive surgery (MIS), utilization of MIS in the Medicare population is highly variable and tends to be lower than in the general population. We sought to compare the post-operative and economic outcomes of MIS versus open surgery for seven common surgical procedures in the Medicare population.

methodsUsing the 2014 Medicare Provider Analysis and Review Inpatient Limited Data Set, patients undergoing bariatric, cholecystectomy, colectomy, hysterectomy, inguinal hernia, thoracic, and ventral hernia procedures were identified using DRG and ICD-9 codes. Adjusting for patient demographics and comorbidities, the odds of complication and all-cause 30-day re-admission were compared among patients undergoing MIS versus open surgery stratified by operation type. A generalized linear model was used to calculate the estimated difference in length of stay (LOS), Medicare claim cost, and Medicare reimbursement.

resultsAmong 233,984 patients, 102,729 patients underwent an open procedure versus 131,255 who underwent an MIS procedure. The incidence of complication after MIS was lower for 5 out of the 7 procedures examined (OR 0.36-0.69). Re-admission was lower for MIS for 6 out of 7 procedures (OR 0.43-0.87). MIS was associated with shorter LOS for 6 procedures (point estimate range 0.35-2.47 days shorter). Medicare claim costs for MIS were lower for 4 (range $3010.23-$4832.74 less per procedure) and Medicare reimbursements were lower for 3 (range $841.10-$939.69 less per procedure).

conclusionsMIS benefited Medicare patients undergoing a range of surgical procedures. MIS was associated with fewer complications and re-admissions as well as shorter LOS and lower Medicare costs and reimbursements versus open surgery. MIS may represent a better quality and cost proposition in the Medicare population.

Indexed as

AgedAged, 80 and overCost-Benefit AnalysisDigestive System Surgical ProceduresFemaleHumansLength of StayMaleMedicareMinimally Invasive Surgical ProceduresPostoperative ComplicationsUnited StatesBariatricCholecystectomyColectomyHerniaMedicareMIS

Identifiers

PMID29484556

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.