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Financial implications of laparoscopic hot gallbladder service in a nontertiary District General Hospital
Sayantan Bhattacharya1, Tom Richardson1, Gerlin Naidoo1
1Department of General Surgery, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK.
Insights
Expediting index admission laparoscopic cholecystectomy (IALC) for acute cholecystitis can significantly increase hospital revenue and reduce patient waiting times. This approach optimizes resource use and improves operating list efficiency.
Area of Science:
- Surgical Innovation
- Health Economics
- Hospital Management
Background:
- Index admission laparoscopic cholecystectomy (IALC) is recommended but often limited in non-tertiary centers due to resource and financial constraints.
- Current practices result in delays, impacting patient care and hospital efficiency.
Purpose of the Study:
- To evaluate the financial and operational benefits of performing IALC on the day of admission for acute cholecystitis (AC).
- To assess the potential increase in surplus revenue and reduction in waiting times.
Main Methods:
- Retrospective analysis of 50 eligible patients undergoing IALC at a single-centre District General Hospital.
- Calculation of potential savings based on admission tariffs, bed occupancy, and operating costs.
Main Results:
- Only 38% of patients received IALC on admission, with a median delay of 3 days to surgery.
- Immediate IALC is predicted to increase mean surplus tariff by £2132 per patient, totaling £530,000 annually.
- Expediting IALC is projected to free up 53 day-case slots, generating an additional £95,600 annually and reducing inpatient bed days.
Conclusions:
- Expediting surgery for eligible acute cholecystitis patients significantly increases hospital revenue.
- Reducing preoperative stay through immediate IALC optimizes operating list usage and reduces inpatient bed occupancy.
- Implementing immediate IALC offers substantial financial and operational advantages for healthcare facilities.
Introduction:
The service of providing index admission laparoscopic cholecystectomy (IALC), as recommended by NIC guidelines, often falls short in nontertiary centres because of a combination of limited resources and financial constraints.
Methods:
This retrospective study in a single-centre District General Hospital included 50 patients, eligible to undergo IALC, and calculated potential savings from performing IALC on the day of admission by considering admission tariffs, bed, and operating costs.
Results:
The IALC was provided in 19 patients (38%), with a mean delay from admission to operation of (median) 3 days. Mean surplus tariff was £1421 and £1571 in IALC and non-IALC groups, respectively. Performing immediate IALC (on the day of admission) for acute cholecystitis (AC) is predicted to increase mean surplus tariff to £2132 per patient, raising total predicted annual surplus by £53 000. Immediate IALC is also predicted to reduce waiting time for day-case LC by freeing up 53 day-case slots, attracting additional £95 600 annually, along with freeing up many inpatient bed days.
Conclusions:
This study demonstrates that reduction of preoperative stay in AC by expediting operations in every eligible patient promises significant surplus revenue. Additional advantages include reducing inpatient bed days and freeing up operating lists that are otherwise taken up by patients for interval cholecystectomy.
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