Hospital cost categories of one-stage versus two-stage management of common bile duct stones
- 238 Downloads
In the era of cost-conscious healthcare, hospitals are focusing on costs. Analysis of hospital costs per cost category may provide indications for potential cost-saving measures in the management of common bile duct stones (CBDS) with gallbladder in situ.
Between October 2005 and September 2006, 53 consecutive patients suffering from CBDS underwent either a one-stage procedure [laparoscopic common bile duct exploration (LCBDE) with stone clearance and cholecystectomy (LCCE)] or a two-stage procedure [endoscopic retrograde cholangiopancreatography with sphincterotomy and stone clearance (ERCP/ERS) followed by LCCE]. Costs were defined in different cost categories for each activity centre and were linked to the individual patient via the “bill of activities”. Only patients (n = 38) with an uneventful post-procedural course and with available cost data were considered for cost analysis. Total length of hospital stay (LOS) was 2 (0–6) days after one-stage and 8 (3–18) days after two-stage procedure (p < 0.0001).
Costs per patient were significantly (p < 0.0001) less after one-stage versus two-stage management, i.e. total hospital costs (€2,636 versus €4,608), hospitalisation costs (€701 versus €2,190), consumables/pharmacy (€645 versus €1,476) and para-medical personnel (€1,035 versus €1,860; p = 0.0002). Operation room (OR) costs were comparable for one-stage and two-stage management (€1,278 versus €1,232; p = 0.280). Total hospital costs during ERCP were €2,648 (€729–4,544), during LCCE without LCBDE were €2,101 (€1,033–4,269), and during LCCE with LCBDE were €2,636 (€1,176–4,235).
In the management of patients with CBDS and gallbladder in situ a one-stage procedure is associated with significantly less costs as compared with a two-stage procedure. From the economical point of view these patients should preferably be treated via a one-stage procedure as long as safety and efficacy of this approach are provided.
KeywordsLaparoscopy Cost Bile duct stone Healthcare
- 11.Martin DJ, Vernon DR, Toouli J (2006) Surgical versus endoscopic treatment of bile duct stones (Review). Cochrane Database Syst Rev, April 19 (2):CD003327Google Scholar
- 13.Arregui ME, Davis CJ, Arkush AM, Nagan RF (1992) Laparoscopic cholecystectomy combined with endoscopic sphincterotomy and stone extraction or laparoscopic choledochoscopy and electrohydraulic lithotripsy for management of cholelithiasis with choledocholithiasis. Surg Endosc 6:10–15CrossRefPubMedGoogle Scholar