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Resource use for cholecystectomy with versus without cholangiography: A multicenter, propensity-matched analysis
Amanda C Filiberto1, Molly Q Nyren2, Patrick W Underwood3
1Department of Surgery, University of Florida Health, Gainesville, FL.
Insights
Intraoperative cholangiography during laparoscopic cholecystectomy reduces resource use and costs by lowering the need for and timing of follow-up procedures. This aids in earlier identification of bile duct issues, improving patient outcomes.
Area of Science:
- Gastroenterology and Hepatobiliary Surgery
- Surgical Outcomes Research
- Health Economics in Medicine
Background:
- Intraoperative cholangiography (IOC) aids in identifying common bile duct (CBD) injuries and choledocholithiasis during laparoscopic cholecystectomy (LC).
- The impact of IOC on resource utilization for biliary pathology remains under investigation.
- This study evaluated resource use in LC patients with versus without IOC.
Purpose of the Study:
- To test the hypothesis that IOC does not alter resource use in patients undergoing LC.
- To compare the incidence, timing, and costs associated with postoperative endoscopic retrograde cholangiography (ERC) in patients who did and did not receive IOC during LC.
Main Methods:
- A retrospective, longitudinal cohort study of 3,151 LC patients from three university hospitals.
- Propensity score matching was used to compare 830 patients who underwent IOC with 795 who did not.
- Primary outcomes included postoperative ERC incidence, time to ERC, and total direct costs.
Main Results:
- The IOC group showed a lower incidence of postoperative ERC (2.4% vs. 4.3%, P=.04) and a shorter interval to ERC (2.5 vs. 4.5 days, P=.04).
- Patients receiving IOC experienced a significantly shorter length of hospital stay (0.3 vs. 1.4 days, P<.001) and lower total direct costs ($4.0K vs. $8.1K, P<.001).
- No significant differences in 30-day or 1-year mortality were observed between the groups.
Conclusions:
- IOC during LC is associated with decreased resource utilization compared to LC without IOC.
- The reduction in resource use is primarily driven by a lower incidence and earlier timing of postoperative ERC.
- IOC offers a cost-effective approach, potentially improving patient management for biliary pathology during LC.
Background:
Intraoperative cholangiography may allow for earlier identification of common bile duct injury and choledocholithiasis. The role of intraoperative cholangiography in decreasing resource use related to biliary pathology remains unclear. This study tests the null hypothesis that there is no difference in resource use for patients undergoing laparoscopic cholecystectomy with versus without intraoperative cholangiography.
Methods:
This retrospective, longitudinal cohort study included 3,151 patients who underwent laparoscopic cholecystectomy at 3 university hospitals. To minimize differences in baseline characteristics while maintaining adequate statistical power, propensity scores were used to match 830 patients who underwent intraoperative cholangiography at surgeon discretion and 795 patients who underwent cholecystectomy without intraoperative cholangiography. Primary outcomes were the incidence of postoperative endoscopic retrograde cholangiography, the interval between surgery and endoscopic retrograde cholangiography, and total direct costs.
Results:
In the propensity-matched analysis, the intraoperative cholangiography and no intraoperative cholangiography cohorts had similar age, comorbidities, American Society of Anesthesiologists Sequential Organ Failure Assessment scores, and total/direct bilirubin ratios. The intraoperative cholangiography cohort had a lower postoperative endoscopic retrograde cholangiography (2.4% vs 4.3%; P = .04), a shorter interval between cholecystectomy and endoscopic retrograde cholangiography (2.5 [1.0-17.8] vs 4.5 [2.0-9.5] days; P = .04), and shorter length of stay (0.3 [0.2-1.5] vs 1.4 [0.3-3.2] days; P < .001). Patients undergoing intraoperative cholangiography had lower total direct costs ($4.0K [3.6K-5.4K] vs $8.1K [4.9K-13.0K]; P < .001). There were no differences in 30-day or 1-year mortality among the cohorts.
Conclusion:
Compared with laparoscopic cholecystectomy without intraoperative cholangiography, cholecystectomy with intraoperative cholangiography was associated with decreased resource use, which was primarily attributable to decreased incidence and the earlier timing of postoperative endoscopic retrograde cholangiography.
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