Laparoscopic Cholecystectomy: A Retrospective Analysis of Hospital Costs and Clinical Outcomes in Patients Undergoing Conventional, Single Port, and Micro-laparoscopic Surgery

Edward Chekan, MD FACS, Mathew Moore, MHA, Tina Hunter, PhD, Candace Gunnarsson, EdD. Ethicon Endo-Surgery, Inc Cincinnati, Ohio; S2 Statistical Solutions, Inc Cincinnati, Ohio

Introduction: This study compares hospital costs and clinical outcomes for traditional laparoscopic (LC), single port surgery (SPS) and micro-laparoscopic (MLC) cholecystectomy procedures from Premier hospitals across the United States.

Methods: Eligible patients were those of any age undergoing LC in the Premier hospital database for the years 2009 -Q2 2010. Patients were categorized into three groups: LC, SPS or MLC, based on ICD-9 codes and hospital charge descriptions for the surgical tools utilized. A procedure was considered to be MLC if: no SPS products were identified in the charge master descriptions; the patient had a record of at least one product <5mm used; there was not more than one product >5mm used and any other products identified were =5mm. Summary statistics were generated for all three groups. Multivariable analyses were performed for outpatient procedures on hospital costs and clinical outcomes. All multivariable models were adjusted for patient demographics, patient severity, comorbid conditions, and hospital characteristics.

Results: In the outpatient setting, when SPS was utilized, hospital costs were approximately $834 more than MLC and $964 more than LC (p < 0.0001). Adverse events were significantly higher (p < 0.0001) for SPS compared to MLC [95% CI for odds ratio (1.38 – 2.68)] and SPS compared to LC [95% CI for odds ratio (1.37 to 2.35)]. MLC hospital costs were statistically significantly (p < 0.0001) lower than LC by $211 and there were no significant differences in adverse events.

Conclusions: In the outpatient setting, single port surgery costs approximately 22% more and has higher adverse events than micro-laparoscopic and traditional laparoscopy. Micro-laparoscopic costs approximately 5% less than traditional laparoscopy with no differences in adverse events. These findings could influence technique choice for patients requiring cholecystectomy.
 

View Poster