Impact of Minimally Invasive Surgery on Medical Spending and Employee Absenteeism | Cardiothoracic Surgery | JAMA Surgery | JAMA Network
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Congressional Budget Office. The 2012 long-term budget outlook, June 2012. Accessed November 30, 2012.
DeNavas-Walt  C, Proctor  BD, Smith  JC.  Income, Poverty, and Health Insurance Coverage in the United States: 2010. Washington, DC: US Census Bureau; 2011.
Barbash  GI, Glied  SA.  New technology and health care costs: the case of robot-assisted surgery.  N Engl J Med. 2010;363(8):701-704.PubMedGoogle ScholarCrossref
Steiner  CA, Bass  EB, Talamini  MA, Pitt  HA, Steinberg  EP.  Surgical rates and operative mortality for open and laparoscopic cholecystectomy in Maryland.  N Engl J Med. 1994;330(6):403-408.PubMedGoogle ScholarCrossref
Escarce  JJ, Chen  W, Schwartz  JS.  Falling cholecystectomy thresholds since the introduction of laparoscopic cholecystectomy.  JAMA. 1995;273(20):1581-1585.PubMedGoogle ScholarCrossref
Carls  GS, Lee  DW, Ozminkowski  RJ, Wang  SH, Gibson  TB, Stewart  E.  What are the total costs of surgical treatment for uterine fibroids?  J Womens Health (Larchmt). 2008;17(7):1119-1132.PubMedGoogle ScholarCrossref
Elixhauser  A, Steiner  C, Harris  DR, Coffey  RM.  Comorbidity measures for use with administrative data.  Med Care. 1998;36(1):8-27.PubMedGoogle ScholarCrossref
Allison  PD.  Missing Data. Thousand Oaks, CA: Sage; 2002.
Vickers  AJ, Altman  DG.  Statistics notes: analysing controlled trials with baseline and follow up measurements.  BMJ. 2001;323(7321):1123-1124.PubMedGoogle ScholarCrossref
Manning  WG, Mullahy  J.  Estimating log models: to transform or not to transform?  J Health Econ. 2001;20(4):461-494.PubMedGoogle ScholarCrossref
Kleinman  LC, Norton  EC.  What’s the risk? a simple approach for estimating adjusted risk measures from nonlinear models including logistic regression.  Health Serv Res. 2009;44(1):288-302.PubMedGoogle ScholarCrossref
Lee  DW, Gibson  TB, Carls  GS, Ozminkowski  RJ, Wang  SH, Stewart  EA.  Uterine fibroid treatment patterns in a population of insured women.  Fertil Steril. 2009;91(2):566-574.PubMedGoogle ScholarCrossref
Hawkins  K, Wang  S, Rupnow  MFT.  Indirect cost burden of migraine in the United States.  J Occup Environ Med. 2007;49(4):368-374.PubMedGoogle ScholarCrossref
US Social Security Administration. National average wage index. Accessed November 30, 2012.
Original Investigation
July 2013

Impact of Minimally Invasive Surgery on Medical Spending and Employee Absenteeism

Author Affiliations
  • 1Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, US Department of Veterans Affairs, Philadelphia, Pennsylvania
  • 2Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 3Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
JAMA Surg. 2013;148(7):641-647. doi:10.1001/jamasurg.2013.131

Importance  As many surgical procedures have undergone a transition from a standard, open surgical approach to a minimally invasive one in the past 2 decades, the diffusion of minimally invasive surgery may have had sizeable but overlooked effects on medical expenditures and worker productivity.

Objective  To examine the impact of standard vs minimally invasive surgery on health plan spending and workplace absenteeism for 6 types of surgery.

Design  Cross-sectional regression analysis.

Setting  National health insurance claims data and matched workplace absenteeism data from January 1, 2000, to December 31, 2009.

Participants  A convenience sample of adults with employer-sponsored health insurance who underwent either standard or minimally invasive surgery for coronary revascularization, uterine fibroid resection, prostatectomy, peripheral revascularization, carotid revascularization, or aortic aneurysm repair.

Main Outcomes and Measure  Health plan spending and workplace absenteeism from 14 days before through 352 days after the index surgery.

Results  There were 321 956 patients who underwent surgery; 23 814 were employees with workplace absenteeism data. After multivariable adjustment, mean health plan spending was lower for minimally invasive surgery for coronary revascularization (−$30 850; 95% CI, −$31 629 to −$30 091), uterine fibroid resection (−$1509; 95% CI, −$1754 to −$1280), and peripheral revascularization (−$12 031; 95% CI, −$15 552 to −$8717) and higher for prostatectomy ($1350; 95% CI, $611 to $2212) and carotid revascularization ($4900; 95% CI, $1772 to $8370). Undergoing minimally invasive surgery was associated with missing significantly fewer days of work for coronary revascularization (mean difference, −37.7 days; 95% CI, −41.1 to −34.3), uterine fibroid resection (mean difference, −11.7 days; 95% CI, −14.0 to −9.4), prostatectomy (mean difference, −9.0 days; 95% CI, −14.2 to −3.7), and peripheral revascularization (mean difference, −16.6 days; 95% CI, −28.0 to −5.2).

Conclusions and Relevance  For 3 of 6 types of surgery studied, minimally invasive procedures were associated with significantly lower health plan spending than standard surgery. For 4 types of surgery, minimally invasive procedures were consistently associated with significantly fewer days of absence from work.