Surgical Endoscopy

, Volume 24, Issue 2, pp 413–416 | Cite as

Hospital cost categories of one-stage versus two-stage management of common bile duct stones

  • B. Topal
  • K. Vromman
  • R. Aerts
  • C. Verslype
  • W. Van Steenbergen
  • F. Penninckx
Article

Abstract

Background

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.

Methods

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).

Results

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).

Conclusion

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.

Keywords

Laparoscopy Cost Bile duct stone Healthcare 

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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • B. Topal
    • 1
    • 2
  • K. Vromman
    • 3
  • R. Aerts
    • 1
  • C. Verslype
    • 4
  • W. Van Steenbergen
    • 4
  • F. Penninckx
    • 1
  1. 1.Department of Abdominal SurgeryUniversity Hospital LeuvenLeuvenBelgium
  2. 2.Department of Abdominal SurgeryUniversity Hospital GasthuisbergLeuvenBelgium
  3. 3.Department of Management Information & ReportingUniversity Hospital LeuvenLeuvenBelgium
  4. 4.Department of Internal MedicineUniversity Hospital LeuvenLeuvenBelgium

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