Clinical and financial aspects of cholecystectomy: laparoscopic versus open technique

Clinical and financial aspects of laparoscopic (LC) (n = 119) and open (OC) (n = 117) cholecystectomy are compared in a retrospective study. The number and nature of perioperative complications do not differ importantly between these techniques. In favor of LC, significant differences are observed regarding the numbers of days severe pain was suffered (mean 1.7 days versus 5.4 days), the total number of days pain was suffered (mean 7.0 days versus 12.2 days), the number of postoperative days in hospital (mean 3.1 days versus 8. 8 days), the extent of perioperative monitoring performed, and the number of days before patients could return to (every day) work (mean 12.8 days versus 34.8 days). In this study total charges for LC (hospital and professional charges) are significantly lower than the total charges for OC [means, in dutch guilders (DG) were 4425 for LC versus 9215 for OC; $1 US = 1.93 DG]. The difference is the result of fewer days of postoperative hospitalization and reduced perioperative screening for LC. Furthermore, hospital charges for LC in The Netherlands (DG 3655) are less expensive than average hospital charges reported so far (US $1894 compared to $4948). For the hospital itself, however, on an annual base LC might well be more expensive than OC because of a maximum quota-annex-budgetizing system installed by the government to keep national health care costs controllable and low. In conclusion, LC has clear advantages over OC in clinical, social, and financial respects. Unjustly, the hospital does not seem to gain financial benefit from this fact.