Cost Effectiveness of Laparoscopic Cholecystectomy

Abstract

An investigation was undertaken to determine whether hospital charges for laparoscopic cholecystectomy are higher than those for traditional open cholecystectomy. Thirty consecutive cases of successfully completed laparoscopic procedures in a single surgeon's experience were compared to 30 open cases performed within the previous calendar year. Patients undergoing open cholecystectomy were excluded if coexisting medical problems or complications prolonged hospitalization beyond 7 days. Mean patient age was comparable (open cholecystectomy = 47.3 +/- 2.9, laparoscopic cholecystectomy = 46.5 +/- 2.7 years), as was the incidence of other significant medical problems. Average duration of hospitalization was significantly longer for open cholecystectomy (3.6 = 0.2 days) than for laparoscopic cholecystectomy (1.0 +/- days, p less than .001). Average hospital charges for open cholecystectomy were $5606 +/- 496 and for laparoscopic cholecystectomy $4726 +/- 98. Hospital charges from operating room and recovery room charges alone were $2684 +/- 131 for laparoscopic cholecystectomy and $2196 +/- 113 for open cholecystectomy. These operating room charges represent a significantly higher percentage of total hospital charges for laparoscopic cholecystectomy than open cholecystectomy patients (laparoscopic cholecystectomy = 56.3 +/- 1.9%, open cholecystectomy = 41.2 +/- 1.5%, p less than .05). Average time for return to work or normal activity was significantly shorter for laparoscopic cholecystectomy 8.6 +/- 9 days) than for open cholecystectomy (32.4 +/- 3.6 days, p less than .001). The authors conclude that laparoscopic cholecystectomy is a cost effective procedure for the treatment of symptomatic cholelithiasis, and that increased operative costs more than offset the significantly decreased length of hospitalization.

Patient attitudes and expectations regarding natural orifice translumenal endoscopic surgery

“…The majority saw little need for laparoscopic cholecystectomy, perceived a need to wait for prospective outcomes data, or condemned it as a conceptually ''bad'' or ''pointless'' idea. Indeed, early studies seemed to show that laparoscopic cholecystectomy resulted in little patient benefit (besides cosmesis) [7], increased cost to society [8], and had some potential for patient harm [9].…”

Laparoscopic colposuspension Is it cost-effective?

“…Laparoscopic cholecystectomy has been assessed clinically and there are now many studies analyzing the cost benefit of the procedure, particularly in relation to different fractions within the health system [5,18,19,39,43,47]. Likewise, there are a few papers that analyze the costs involved in laparoscopic appendectomy, fundoplication, and herniorrhaphy [4,10,15,29].…”

Public Perception of “Scarless” Surgery: A Critical Analysis of the Literature

“…Early studies showed that laparoscopy resulted in little patient benefit, increased cost, and potential harm to patients. 11 The public, however, with help from the lay press and industry, essentially demanded that their surgeons provide this innovative operation. Thus, the rapid dissemination and establishment as the current gold standard was actually driven largely by public demand.…”