Original Investigation |

Impact of Minimally Invasive Surgery on Medical Spending and Employee Absenteeism

Andrew J. Epstein, PhD1,2,3; Peter W. Groeneveld, MD, MS1,2,3; Michael O. Harhay, MPH2; Feifei Yang, MS2; Daniel Polsky, PhD2,3
[+] 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.
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Published online

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.

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