Providing the Best Value Care for Emergent Gallbladder Disease
Shelbie Kirkendoll, DO, MS1,2, Aixa M. Perez Coulter, MS, MPH1, Kristina Kramer, MD1, Reginald Alouidor, MD, FACS1, Adin Tyler Putnam, MD, FACS1, Eleanor Sue Winston, MD, FACS1, Gabriel Ryb, MD, FACS1, Edward Kelly, MD, FACS1, Nicholas Jabbour, MD, FACS1, Tovy Haber Kamine, MD1
1Baystate Medical Center, Springfield, MA 2 Health System Las Vegas, Las Vegas, NV
Background Laparoscopic cholecystectomy performed <72 hours from hospital admission has shown decreased hospital costs without an increase in length of stay (LOS), however, few studies have examined clinical and cost outcomes of performing cholecystectomy <24 hours from hospital admission.
Methods We performed a retrospective observational study of 1,037 patients who underwent laparoscopic cholecystectomy between 1/1/18-2/28/20. We evaluated LOS, operative duration, and hospital cost.
Results 468 patients (53%) underwent urgent cholecystectomy, and 411 patients (47%) underwent elective cholecystectomy, of which 97 (20%) had ?1 emergency department (ED) visit before their outpatient surgery. Median time between first and second ED visit was 19.16 days. Mean LOS (13.4 hrs v. 70.4 hrs, p<0.01) and hospital cost ($12,868.20 v. $26,611.20, p<0.01) was lower for patients undergoing elective vs. urgent cholecystectomy. For urgent patients undergoing cholecystectomy, those performed <24 hours from admission had a decreased LOS (43.6 hrs v. 102.9 hrs, p <0.01) and decreased hospital cost ($23,736.70 v. $30,176.40, p<0.01) than those performed >24 hours from admission.
Conclusion Urgent cholecystectomy performed <24 hours of hospital admission was more cost effective than delayed urgent cholecystectomy and elective cholecystectomy had lower cost than urgent cholecystectomy, however, many patients who present to the ED will represent, so elective cholecystectomy for patients seen in the ED for biliary colic maybe preferable to outpatient follow up.
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