Resource use for cholecystectomy with versus without cholangiography: A multicenter, propensity-matched analysis

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.