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Bare bones laparoscopy: a randomized prospective trial of cost savings in laparoscopic cholecystectomy
Matthew R Brackman1, Eva Foley, Jesus Esquivel
1Washington Hospital Center Department of Surgery, and Division of Surgery, Kaiser Permanente, Washington, DC, USA. mbrackman@yahoo.com
Objective:
Rising costs and lowered reimbursements make value essential if laparoscopic cholecystectomy (LC) is to be offered to patients without condemning providers to financial loss. We hypothesize that our protocol increases this value. Once practiced, operative time, complications, and patient satisfaction compare with those of the typical method.
Methods:
We prospectively randomized 50 consecutive patients equally to control or experimental LC according to our protocol. Equipment costs, operative time, conversions, complications, pain, and return to work were compared. The student's t test was used for comparisons.
Results:
Mean disposable equipment costs were 173.00 dollars +/- 43.45 dollars and 434.42 dollars +/- 50.54 dollars for the study and control groups, respectively (P < .0001). Mean operative times were 67.26 +/- 15 and 70.60 +/- 19 minutes, respectively.
Conclusions:
The "bare bones" protocol is safe. It has a short learning curve, demonstrates a cost advantage over the common method, and requires no additional operative time. Pain, time to return to work, and satisfaction are equivalent.