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.
MethodsBetween 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).
ResultsCosts 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).
ConclusionIn 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.
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Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
B. Topal, R. Aerts & F. Penninckx
Department of Abdominal Surgery, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium
B. Topal
Department of Management Information & Reporting, University Hospital Leuven, Leuven, Belgium
K. Vromman
Department of Internal Medicine, University Hospital Leuven, Leuven, Belgium
C. Verslype & W. Van Steenbergen
Correspondence to B. Topal.
About this article Cite this articleTopal, B., Vromman, K., Aerts, R. et al. Hospital cost categories of one-stage versus two-stage management of common bile duct stones. Surg Endosc 24, 413–416 (2010). https://doi.org/10.1007/s00464-009-0594-0
Received: 25 February 2009
Accepted: 31 May 2009
Published: 25 June 2009
Issue Date: February 2010
DOI: https://doi.org/10.1007/s00464-009-0594-0
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