Laparoscopic Cholecystectomy-Related Bile Duct Injuries: A ... : Annals of Surgery (original) (raw)
Advances in Surgical Technique: Original Articles
A Health and Financial Disaster
Savader, Scott J. M.D.*; Lillemoe, Keith D. M.D.†; Prescott, Carol A. R.N.*; Winick, Adam B. M.D.*; Venbrux, Anthony C. M.D.*; Lund, Gunnar B. M.D.*; Mitchell, Sally E. M.D.*; Cameron, John L. M.D.†; Osterman, Floyd A. Jr. M.D.*
From Russell H. Morgan Department of Radiology and Radiological Science, Division of Cardiovascular and Interventional Radiology,* and the Department of Surgery,† The Johns Hopkins Medical Institutions, Baltimore, Maryland
Address reprint requests to Scott J. Savader, M.D., Johns Hopkins Medical Institutions, Department of Radiology, Division of Cardiovascular and Interventional Radiology, Blalock 545, 600 North Wolfe Street, Baltimore, MD 21287.
Accepted for publication March 8, 1996.
Abstract
Objective
This study was designed to evaluate the total costs associated with repair of laparoscopic cholecystectomy (LC)-related bile duct injuries.
Summary Background Data
The popularity of LC with both patients and surgeons is such that this procedure now exceeds open cholecystectomy by a ratio of approximately 4 to 10:1. However, costs associated with LC-related injuries, particularly regarding treatment patterns, have up to now not been explored fully.
Methods
The complete hospital and interventional radiology (IR) billing records for 49 patients who have completed treatment for laparoscopic cholecystectomy-related bile duct injuries were divided into 8 categories. These records were totaled for comparison of costs between patient groups that experienced different injuries and treatment patterns.
Results
Patients with LC-related bile duct injuries were billed a mean of $51,411 for all care related to repair of their bile duct injury. Patients incurred an average of 32 days of inpatient hospitalization and 10 outpatient care days. Postoperative treatment included long-term chronic biliary intubation averaging 378 days. Two patients (4%) died as a result of their LC-related complications. Patients with bile duct injuries that were recognized immediately at the time of the initial surgery ultimately experienced a total cost for their repair and hospitalization of 43% to 83% less than for patients in whom recognition of the injury was delayed (p < 0.019 to 0.070). In addition, the total hospitalization and outpatient care days was reduced by as much as 76% with early recognition of an iatrogenic injury.
Conclusions
Repair of cholecystectomy-related bile duct injuries can run 4.5 to 26.0 times the cost of the uncomplicated procedure and carries a significant mortality rate. Intraoperative recognition of such an injury with immediate conversion to an open procedure for definitive repair can result in significant cost savings and relates directly to a decreased morbidity, mortality, length of hospitalization, and number of outpatient care days.
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