Is pediatric laparoscopic splenectomy safe and cost-effective?

OBJECTIVE To determine whether laparoscopic splenectomy (LS) is a safe, cost-effective alternative to open splenectomy (OS). DESIGN Retrospective comparison and economic evaluation. SETTING Tertiary care children's hospital. PATIENTS Children with hematologic disease involving the spleen. INTERVENTIONS Laparoscopic splenectomy (10 patients); OS (10 patients). MAIN OUTCOME MEASURES Safety of LS and cost differential between LS and OS. RESULTS Operative time was longer for LS. Discharge occurred 64 hours postoperatively for LS and 79 hours for OS (P < .03). Patients who underwent LS returned to activity 1 to 5 weeks faster than patients who underwent OS. The average (+/-SD) operative charges for LS was $7176 +/- $2064 and for OS, $1977 +/- $344 (P < .001). Total hospital charges averaged $13,033 +/- $2976 for LS and $7106 +/- $1923 for OS (P < .001). CONCLUSIONS Laparoscopic splenectomy can be performed safely in children. In our hospital, LS is more expensive than OS. The faster return to school and normal activity warrants the continued use of this procedure despite the increased cost.