Economic Implications of Providing Emergency Cholecystectomy for All Patients With Biliary Pathology: A Retrospective Analysis.

INTRODUCTION

This study assessed the safety and efficacy of acute laparoscopic cholecystectomy (ALC) in patients presenting with biliary pathology. The potential savings plus income generation for the hospital were calculated.

METHODS

All patients undergoing emergency cholecystectomy were identified from computerized and hand-written theater records to ensure complete capture. Length of stay, procedure time, patient demographics, and postoperative complications were recorded. Tariffs for conservative versus acute management were calculated. Total admissions and readmissions with biliary pathology (acute cholecystitis, biliary colic, gallstone pancreatitis, and obstructive jaundice) over a 12-month period were recorded.

RESULTS

Eighty-four patients undergoing ALC were identified. There was only 1 major complication (1 postoperative bleed managed laparoscopically). ALC for all admissions would result in savings of £ 695,918 over 12 months. The implementation of ALC for all patients would result in a small loss in revenue when compared with elective laparoscopic cholecystectomy (£ 15,495) provided that all operations could be accommodated on established operating lists. Implementing ALC on all appropriate biliary admissions could generate up to 3 cholecystectomies daily for a population base of 1 million.

CONCLUSIONS

ALC is cost-effective and safe. It can be offered to all patients with biliary pathology provided they are fit enough for surgery.