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Laparoscopic cholecystectomy: its impact on national health economics
H C Vandenbergh1, T Wilson, S E Adams
1Institute for Minimally Invasive Surgery, Sydney Hospital, NSW.
Objective:
To assess whether sound economic reasons exist for the wider introduction of laparoscopic cholecystectomy in Australia.
Design:
A retrospective survey of patients who underwent laparoscopic cholecystectomy. We compared time of hospital stay and time off work after laparoscopic cholecystectomy with data for open cholecystectomy.
Patients And Setting:
Seventeen participating surgeons in four Australian States allowed access to patients treated between May 1990 and November 1991 (1254 patients in all).
Main Outcome Measures:
Patient acceptability of the procedure, average length of postoperative in-hospital stay, and the savings associated with earlier return to work compared with open cholecystectomy.
Results:
Almost 90% of patients (1127) replied and 1088 responses were considered appropriate for analysis. Serious complications were rare; 96% of patients thought the technique was successful. The mean length of in-hospital stay was 2.6 days (range, 1-120), compared with a mean of 8.7 days for open cholecystectomy. Among working patients, the mean time to return to work was 11.6 days (range, 10.7-13.1), an estimated 27 days sooner than after open cholecystectomy. Extrapolating from these results, replacing 95% of open cholecystectomies with laparoscopic procedures would have 133,285 hospital bed-days and 500,000 work-days each year.
Conclusion:
Laparoscopic cholecystectomy is safe and effective. Its wider use in Australia would result in savings to both the individual and the national economy.