The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan

Yoshiyuki Hoya; Tomoyoshi Okamoto; Norio Mitsumori; Katsuhiko Yanaga

doi:doi:10.11648/j.ass.20170504.13

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The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan

Yoshiyuki Hoya, Tomoyoshi Okamoto, Norio Mitsumori, Katsuhiko Yanaga

Published in Advances in Surgical Sciences (Volume 5, Issue 4)

Received: 18 February 2017 Accepted: 29 June 2017 Published: 31 July 2017

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Abstract

The utility and problems including the socioeconomic aspect of laparoscopy-assisted (LADG) and laparoscopic distal gastrectomy (LDG) for gastric cancer has not been fully evaluated. We compared between open distal gastrectomy (ODG), LADG and LDG, the clinical benefit and quality of life by the reference documents. The problems of operation cost were derived by simulating the material used for each operation with Billroth I (B-I) reconstruction, and calculating the operation fee under the national health insurance system in Japan. The operation time of LADG and LDG was longer than that of ODG. However, the intraoperative blood loss of LADG and LDG was less and the postoperative hospital stay as well as the duration of fasting after LADG and LDG were shorter than those after ODG. The number of excised lymph nodes and the incidence of postoperative complications were comparable between LADG, LDG and ODG. On the other hand, in the national health insurance system, the operation fee of ODG was US$7187 as compared to US$8012 for LADG and US$7962 for LDG. In spite of the US$825 and US$775 difference in the operation fee, the use of disposable instruments for LADG and LDG results in the deficit of approximately US$650 and US$850 over ODG, respectively. In spite of the medical superiority of LADG and LDG over ODG as less invasive surgery, LADG and LDG in the current Japanese health insurance system are associated with less financial benefit to the hospital as compared to ODG.

Published in	Advances in Surgical Sciences (Volume 5, Issue 4)
DOI	10.11648/j.ass.20170504.13
Page(s)	53-56
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Laparoscopy-Assisted Distal Gastrectomy, Gastric Cancer, Health Insurance, Minimally Invasive Surgery, Cost Benefit

References

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[3]	Viñuela EF, Gonen M, Brennan MF, Coit DG, Strong VE. Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg 2012; 255: 446-56.
[4]	Kodera Y, Fujiwara M, Ohashi N, Nakayama G, Koike M, Morita S, Nakao A. Laparoscopic surgery for gastric cancer: a collective review with meta-analysis of randomized trials. J Am Coll Surg 2010; 211: 677-86.
[5]	Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 2010; 251: 417-20.
[6]	Cho GS, Kim W, Kim HH, Ryu SW, Kim MC, Ryu SY. Multicentre study of the safety of laparoscopic subtotal gastrectomy for gastric cancer in the elderly. Br J Surg 2009; 96: 1437-42.
[7]	Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 2008; 248: 721-7.
[8]	Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N; Japanese Laparoscopic Surgery Study Group. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 2007; 245: 68-72.
[9]	Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 2005; 241: 232-7.
[10]	Migoh S MD, Hasuda K MD, Nakashima K MD, Anai H MD. The benefit of laparoscopy-assisted distal gastrectomy compared with conventional open distal gastrectomy: a case-matched control study. Hepatogastroenterology 2003; 50: 2251-4.
[11]	Shimizu S, Uchiyama A, Mizumoto K, Morisaki T, Nakamura K, Shimura H, et al. Laparoscopically assisted distal gastrectomy for early gastric cancer: is it superior to open surgery? Surg Endosc 2000; 14: 27-31.
[12]	Yano H, Monden T, Kinuta M, Nakano Y, Tono T, Matsui S, et al. The usefulness of laparoscopy-assisted distal gastrectomy in comparison with that of open distal gastrectomy for early gastric cancer. Gastric Cancer 2001; 4: 93-7.
[13]	Mochiki E, Nakabayashi T, Kamimura H, Haga N, Asao T, Kuwano H. Gastrointestinal recovery and outcome after laparoscopy-assisted versus conventional open distal gastrectomy for early gastric cancer. World J Surg 2002; 26: 1145-9.
[14]	Adachi Y, Shiraishi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S. Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg 2000; 135: 806-10.
[15]	Kasai Y, Fujiwara M, Nakao A. Laparoscopic distal gastrectomy for early gastric cancer. Gastroenterology 2001; 33: 369-75
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APA Style

Yoshiyuki Hoya, Tomoyoshi Okamoto, Norio Mitsumori, Katsuhiko Yanaga. (2017). The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan. Advances in Surgical Sciences, 5(4), 53-56. https://doi.org/10.11648/j.ass.20170504.13

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ACS Style

Yoshiyuki Hoya; Tomoyoshi Okamoto; Norio Mitsumori; Katsuhiko Yanaga. The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan. Adv. Surg. Sci. 2017, 5(4), 53-56. doi: 10.11648/j.ass.20170504.13

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AMA Style

Yoshiyuki Hoya, Tomoyoshi Okamoto, Norio Mitsumori, Katsuhiko Yanaga. The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan. Adv Surg Sci. 2017;5(4):53-56. doi: 10.11648/j.ass.20170504.13

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@article{10.11648/j.ass.20170504.13,
  author = {Yoshiyuki Hoya and Tomoyoshi Okamoto and Norio Mitsumori and Katsuhiko Yanaga},
  title = {The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan},
  journal = {Advances in Surgical Sciences},
  volume = {5},
  number = {4},
  pages = {53-56},
  doi = {10.11648/j.ass.20170504.13},
  url = {https://doi.org/10.11648/j.ass.20170504.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ass.20170504.13},
  abstract = {The utility and problems including the socioeconomic aspect of laparoscopy-assisted (LADG) and laparoscopic distal gastrectomy (LDG) for gastric cancer has not been fully evaluated. We compared between open distal gastrectomy (ODG), LADG and LDG, the clinical benefit and quality of life by the reference documents. The problems of operation cost were derived by simulating the material used for each operation with Billroth I (B-I) reconstruction, and calculating the operation fee under the national health insurance system in Japan. The operation time of LADG and LDG was longer than that of ODG. However, the intraoperative blood loss of LADG and LDG was less and the postoperative hospital stay as well as the duration of fasting after LADG and LDG were shorter than those after ODG. The number of excised lymph nodes and the incidence of postoperative complications were comparable between LADG, LDG and ODG. On the other hand, in the national health insurance system, the operation fee of ODG was US$7187 as compared to US$8012 for LADG and US$7962 for LDG. In spite of the US$825 and US$775 difference in the operation fee, the use of disposable instruments for LADG and LDG results in the deficit of approximately US$650 and US$850 over ODG, respectively. In spite of the medical superiority of LADG and LDG over ODG as less invasive surgery, LADG and LDG in the current Japanese health insurance system are associated with less financial benefit to the hospital as compared to ODG.},
 year = {2017}
}

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TY  - JOUR
T1  - The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan
AU  - Yoshiyuki Hoya
AU  - Tomoyoshi Okamoto
AU  - Norio Mitsumori
AU  - Katsuhiko Yanaga
Y1  - 2017/07/31
PY  - 2017
N1  - https://doi.org/10.11648/j.ass.20170504.13
DO  - 10.11648/j.ass.20170504.13
T2  - Advances in Surgical Sciences
JF  - Advances in Surgical Sciences
JO  - Advances in Surgical Sciences
SP  - 53
EP  - 56
PB  - Science Publishing Group
SN  - 2376-6182
UR  - https://doi.org/10.11648/j.ass.20170504.13
AB  - The utility and problems including the socioeconomic aspect of laparoscopy-assisted (LADG) and laparoscopic distal gastrectomy (LDG) for gastric cancer has not been fully evaluated. We compared between open distal gastrectomy (ODG), LADG and LDG, the clinical benefit and quality of life by the reference documents. The problems of operation cost were derived by simulating the material used for each operation with Billroth I (B-I) reconstruction, and calculating the operation fee under the national health insurance system in Japan. The operation time of LADG and LDG was longer than that of ODG. However, the intraoperative blood loss of LADG and LDG was less and the postoperative hospital stay as well as the duration of fasting after LADG and LDG were shorter than those after ODG. The number of excised lymph nodes and the incidence of postoperative complications were comparable between LADG, LDG and ODG. On the other hand, in the national health insurance system, the operation fee of ODG was US$7187 as compared to US$8012 for LADG and US$7962 for LDG. In spite of the US$825 and US$775 difference in the operation fee, the use of disposable instruments for LADG and LDG results in the deficit of approximately US$650 and US$850 over ODG, respectively. In spite of the medical superiority of LADG and LDG over ODG as less invasive surgery, LADG and LDG in the current Japanese health insurance system are associated with less financial benefit to the hospital as compared to ODG.
VL  - 5
IS  - 4
ER  -

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Author Information

Yoshiyuki Hoya

Department of Surgery, Daisan Hospital, The Jikei University School of Medicine, Tokyo, Japan
Tomoyoshi Okamoto

Department of Surgery, Daisan Hospital, The Jikei University School of Medicine, Tokyo, Japan
Norio Mitsumori

Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
Katsuhiko Yanaga

Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan

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APA Style

Yoshiyuki Hoya, Tomoyoshi Okamoto, Norio Mitsumori, Katsuhiko Yanaga. (2017). The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan. Advances in Surgical Sciences, 5(4), 53-56. https://doi.org/10.11648/j.ass.20170504.13

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ACS Style

Yoshiyuki Hoya; Tomoyoshi Okamoto; Norio Mitsumori; Katsuhiko Yanaga. The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan. Adv. Surg. Sci. 2017, 5(4), 53-56. doi: 10.11648/j.ass.20170504.13

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AMA Style

Yoshiyuki Hoya, Tomoyoshi Okamoto, Norio Mitsumori, Katsuhiko Yanaga. The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan. Adv Surg Sci. 2017;5(4):53-56. doi: 10.11648/j.ass.20170504.13

Copy | Download

@article{10.11648/j.ass.20170504.13,
  author = {Yoshiyuki Hoya and Tomoyoshi Okamoto and Norio Mitsumori and Katsuhiko Yanaga},
  title = {The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan},
  journal = {Advances in Surgical Sciences},
  volume = {5},
  number = {4},
  pages = {53-56},
  doi = {10.11648/j.ass.20170504.13},
  url = {https://doi.org/10.11648/j.ass.20170504.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ass.20170504.13},
  abstract = {The utility and problems including the socioeconomic aspect of laparoscopy-assisted (LADG) and laparoscopic distal gastrectomy (LDG) for gastric cancer has not been fully evaluated. We compared between open distal gastrectomy (ODG), LADG and LDG, the clinical benefit and quality of life by the reference documents. The problems of operation cost were derived by simulating the material used for each operation with Billroth I (B-I) reconstruction, and calculating the operation fee under the national health insurance system in Japan. The operation time of LADG and LDG was longer than that of ODG. However, the intraoperative blood loss of LADG and LDG was less and the postoperative hospital stay as well as the duration of fasting after LADG and LDG were shorter than those after ODG. The number of excised lymph nodes and the incidence of postoperative complications were comparable between LADG, LDG and ODG. On the other hand, in the national health insurance system, the operation fee of ODG was US$7187 as compared to US$8012 for LADG and US$7962 for LDG. In spite of the US$825 and US$775 difference in the operation fee, the use of disposable instruments for LADG and LDG results in the deficit of approximately US$650 and US$850 over ODG, respectively. In spite of the medical superiority of LADG and LDG over ODG as less invasive surgery, LADG and LDG in the current Japanese health insurance system are associated with less financial benefit to the hospital as compared to ODG.},
 year = {2017}
}

Copy | Download

TY  - JOUR
T1  - The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan
AU  - Yoshiyuki Hoya
AU  - Tomoyoshi Okamoto
AU  - Norio Mitsumori
AU  - Katsuhiko Yanaga
Y1  - 2017/07/31
PY  - 2017
N1  - https://doi.org/10.11648/j.ass.20170504.13
DO  - 10.11648/j.ass.20170504.13
T2  - Advances in Surgical Sciences
JF  - Advances in Surgical Sciences
JO  - Advances in Surgical Sciences
SP  - 53
EP  - 56
PB  - Science Publishing Group
SN  - 2376-6182
UR  - https://doi.org/10.11648/j.ass.20170504.13
AB  - The utility and problems including the socioeconomic aspect of laparoscopy-assisted (LADG) and laparoscopic distal gastrectomy (LDG) for gastric cancer has not been fully evaluated. We compared between open distal gastrectomy (ODG), LADG and LDG, the clinical benefit and quality of life by the reference documents. The problems of operation cost were derived by simulating the material used for each operation with Billroth I (B-I) reconstruction, and calculating the operation fee under the national health insurance system in Japan. The operation time of LADG and LDG was longer than that of ODG. However, the intraoperative blood loss of LADG and LDG was less and the postoperative hospital stay as well as the duration of fasting after LADG and LDG were shorter than those after ODG. The number of excised lymph nodes and the incidence of postoperative complications were comparable between LADG, LDG and ODG. On the other hand, in the national health insurance system, the operation fee of ODG was US$7187 as compared to US$8012 for LADG and US$7962 for LDG. In spite of the US$825 and US$775 difference in the operation fee, the use of disposable instruments for LADG and LDG results in the deficit of approximately US$650 and US$850 over ODG, respectively. In spite of the medical superiority of LADG and LDG over ODG as less invasive surgery, LADG and LDG in the current Japanese health insurance system are associated with less financial benefit to the hospital as compared to ODG.
VL  - 5
IS  - 4
ER  -

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