Cost-effectiveness of ambulatory laparoscopic cholecystectomy

The merits of laparoscopic cholecystectomy include faster recovery, less postoperative pain, earlier return to work, and decreased cost. However, there are few economic data comparing laparoscopic cholecystectomy in an ambulatory versus overnight stay setting. In a 12-month period, 74 consecutive cholecystectomies were performed laparoscopically by one surgeon. The ambulatory group consisted of 36 patients who were discharged from the hospital the same day after a mean recovery time of 5 hours (range, 2.25-10.33). Of the remaining 38 patients, 19 were admitted after surgery on 23-hour observation status, and 19 were inpatients. The average hospital cost was significantly less in the ambulatory group than in the observation group, with an 11% mean reduction in cost per patient (P = 0.0061). No patient in either group was readmitted to the hospital within 30 days of surgery. Laparoscopic cholecystectomy can be performed safely in an outpatient setting. The cost savings of ambulatory care versus observation are clearly shown in this study.