Cost-Benefit Analysis of Various Management Algorithms for Suspected Choledocholithiasis

Area of Science:

• Gastroenterology
• Hepatobiliary Surgery
• Medical Management

Background:

• Choledocholithiasis, or bile duct stones, requires effective management strategies.
• Current approaches include endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiopancreatography (MRCP), and surgery.
• Optimizing patient outcomes and resource utilization is crucial.

Purpose of the Study:

• To compare the safety, efficiency, and cost-effectiveness of three management pathways for suspected choledocholithiasis.
• To evaluate hospital length of stay as a primary outcome measure across different treatment strategies.

Main Methods:

• Retrospective analysis of adult patients with suspected choledocholithiasis (2017-2022).
• Patients were categorized into ERCP-first, MRCP-first, or surgery-first management groups.
• Hospital length of stay was compared between groups.

Main Results:

• No statistically significant difference in hospital length of stay was observed among the ERCP-first, MRCP-first, and surgery-first groups (P > .05).
• Patients admitted to a surgical service were discharged, on average, one day earlier than those admitted to a medical service (P = .01).

Conclusions:

• The choice of initial management pathway (ERCP-first, MRCP-first, surgery-first) does not significantly impact hospital length of stay for suspected choledocholithiasis.
• Admission to a surgical service may be associated with a shorter hospital stay, irrespective of the initial diagnostic or therapeutic intervention.