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Cost analysis of laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy in the management of cholecystocholedocholithiasis

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Abstract

Background

Evidence from controlled trials and meta-analyses suggests that laparoendoscopic rendezvous (LERV) is preferable to sequential treatment in the management of common bile duct stones.

Materials and methods

With this retrospective analysis of a prospective database that included consecutive patients treated for cholecystocholedocholithiasis at our institution between January 2007 and July 2015, we compared LERV with sequential treatment. The primary endpoint was global cost, defined as the cost/patient/hospital stay, and the secondary end points were efficacy and morbidity. Fisher’s exact test or Mann–Whitney test was used.

Results

Of a total of 249 consecutive patients, 143 underwent LERV (group A) and 106 a two-stage procedure (group B). Based on an average cost of €613 for 1 day of hospital stay in the General Surgery Department, the overall median cost of treatment was €6403 for group A and €8194 for group B (p < 0.001). Operative time was significantly shorter (p < 0.001), and length of hospital stay was significantly longer for group B (p < 0.001). No mortality in either group was observed. The postoperative complications rate was significantly higher in group B than in group A (24.5 vs. 10.5%; p = 0.003). No significant difference in the postoperative pancreatitis rate or the number of patients with increased serum amylase at 24 h was observed in either group.

Conclusion

Our study suggests that LERV is preferable to sequential treatment not only in terms of less morbidity, but also of lower costs accrued by a shorter hospital stay. However, the longer operative time raises multiple organizational issues in the coordination of surgery and endoscopy services.

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Authors and Affiliations

  1. General Surgery 1U, Department of Surgical Sciences, University of Torino, Torino, Italy

    Aldo Garbarini, Simone Arolfo, Marco Bruno, Roberto Passera, Mario Morino & Alberto Arezzo

  2. General Surgery 2U, Department of Surgical Sciences, University of Torino, Torino, Italy

    Dario Reggio, Giorgia Catalano & Mauro Salizzoni

  3. Department of Paediatric Gastroenterology, Città della Salute e della Scienza University Hospital, Torino, Italy

    Claudio Barletti

  4. Department of Emergency Surgery, Città della Salute e della Scienza University Hospital, Torino, Italy

    Luca Petruzzelli

Authors
  1. Aldo Garbarini
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  2. Dario Reggio
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  3. Simone Arolfo
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  4. Marco Bruno
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  5. Roberto Passera
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  6. Giorgia Catalano
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  8. Mauro Salizzoni
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  9. Mario Morino
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  10. Luca Petruzzelli
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  11. Alberto Arezzo
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Correspondence to Alberto Arezzo.

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Disclosures

Aldo Garbarini, Dario Reggio, Simone Arolfo, Marco Bruno, Roberto Passera, Giorgia Catalano, Claudio Barletti, Mauro Salizzoni, Mario Morino, Luca Petruzzelli, and Alberto Arezzo have no conflicts of interest or financial ties to disclose.

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Garbarini, A., Reggio, D., Arolfo, S. et al. Cost analysis of laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy in the management of cholecystocholedocholithiasis. Surg Endosc 31, 3291–3296 (2017). https://doi.org/10.1007/s00464-016-5361-4

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