Outpatient laparoscopic cholecystectomy: safe and cost effective?

Among the many advantages of laparoscopic cholecystectomy (LC), which has become the standard of care for symptomatic gallbladder disease, is the decrease in hospital stay. Although some studies of outpatient LC are starting to appear, few compare return visits to the hospital up to 30 days after surgery as well as cost of hospitalization between a group of outpatients and overnight admission patients. From January through December 1994, 415 LCs were attempted at Good Samaritan Hospital. Total hospitalization charges were obtained for a comparable subset of the outpatient and 24-h observation patients. There were 229 LCs performed without difficulty on an outpatient basis and 90 performed with a 24-h hold. Of the 229 outpatient LCs, only 1.3% had minor problems related to LC. Of the 90 LCs performed with 24-h hold, only 2.2% had problems related to the LC. The average charge for LC with overnight admission $4,890.37; the average charge for outpatient surgery was $3,669.54 (p < 0.0001). There was no increase in patient morbidity or mortality associated with outpatient LC. The cost savings for outpatient surgery compared with surgery with 24-h admission was 25%.