Economic implications of current surgical management of gastroesophageal reflux disease

Background/Purpose: Surgical management of gastroesophageal reflux disease in children has evolved with the development of laparoscopy. Because concerns persist regarding increased costs associated with this technique, the authors studied the economic parameters of antireflux surgery at their institution. Methods: Seventy-eight patients undergoing either laparoscopic or open fundoplication were studied retrospectively between June 1998 and June 2000 comparing average operating room costs, total inpatient costs, and length of stay. Univariate comparisons were performed using Student's t test, and multivariate analysis was performed using multiple linear regression. Results: Univariate analysis showed that patients receiving the laparoscopic procedure had significantly shorter inpatient stays (2.4 v. 3.96 days; P = .004) than those receiving open procedures. Average operating room costs were similar (laparoscopic, $2,611; open, $2,162; P = .237), but total costs for the laparoscopic procedure were lower ($4,484 v $5,129; P = .006). Multivariate analysis results suggested that in addition to procedure type, patients who required an intensive care unit admission incurred $6,595 in additional total costs (P < .0001) and 4.8 additional hospital days (P < .0001). After controlling for other variables, the laparoscopic procedure did not significantly reduce total hospital costs ($447; P = .192) but was associated with a significant decrease in length of stay of 1.3 days (P < .0001). Conclusion: These results suggest that laparoscopic procedures are comparable with open operations in terms of operative costs and that other factors are important determinants of the costs associated with antireflux surgery in children.