0
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.
Text Size: A A A
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.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
Jobs
brightcove.createExperiences();