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Costs and Utilization of Intraoperative Cholangiography

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Routine intraoperative cholangiography (IOC) has been advocated as a viable strategy to reduce common bile duct injury (CDI) during cholecystectomy. This is predicated, in part, on the low cost of IOC, making it a cost-effective preventive strategy. Using billed hospital charges as a proxy for costs, we sought to estimate costs associated with the performance of IOC.

Methods

The 2001 National Inpatient Survey (NIS) database was assessed for IOC utilization and associated charges. Average charges for hospital admission where the primary procedure was laparoscopic cholecystectomy were compared for those associated with and without the performance of IOC.

Results

Eighteen percent of cholecystectomies were performed in facilities that never perform IOC. Routine IOC (defined as >75% of cholecystectomies performed in any one hospital having a concomitant IOC) was performed in only 11% of hospitals. In the remaining 71% of hospitals, selective IOC was performed. IOCs were associated with US $706–739 in additional hospital charges when performed in conjunction with laparoscopic cholecystectomy. We project a cost of US $371,356 to prevent a single bile duct injury by using routine cholangiography.

Conclusion

We conclude that only a minority of hospitals performs cholecystectomies with routine IOC. Because of the significant amount of hospital charges attributable to IOC, routine IOC is not cost-effective as a preventative measure against bile duct injury during cholecystectomy.

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Abbreviations

CDE:

common duct exploration

IOC:

intraoperative cholangiography

CDI:

common bile duct injury

LOS:

length of stay

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Authors and Affiliations

  1. Division of Gastrointestinal and Endocrine Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd Room E7-126, Dallas, TX, 75390-9156, USA

    Edward H. Livingston, Jordan A. G. Miller, Brian Coan & Robert V. Rege

  2. Veterans Administration North Texas Health Care System, Dallas, TX, USA

    Edward H. Livingston, Jordan A. G. Miller, Brian Coan & Robert V. Rege

  3. Biomedical Engineering, University of Texas, Arlington, Texas, USA

    Edward H. Livingston

Authors
  1. Edward H. Livingston
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  2. Jordan A. G. Miller
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  3. Brian Coan
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  4. Robert V. Rege
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Correspondence to Edward H. Livingston.

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Livingston, E.H., Miller, J.A.G., Coan, B. et al. Costs and Utilization of Intraoperative Cholangiography. J Gastrointest Surg 11, 1162–1167 (2007). https://doi.org/10.1007/s11605-007-0209-9

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  • DOI: https://doi.org/10.1007/s11605-007-0209-9

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