Elizabeth M Pontarelli, MD, Gary G Grinberg, MD, Pandu R Yenumula, MD. Kaiser Permanente Northern California
Introduction: Laparoscopic Cholecystectomy is the most common procedure performed by general surgeons in the United States, with approximately 600,000 procedures performed annually. As the cost of care rises, there is increasing emphasis on utilization and quality. Our objective was to evaluate the cost of laparoscopic cholecystectomy in our health system and to compare the operative times and outcomes at high and low cost centers.
Methods and Procedures: We evaluated all laparoscopic cholecystectomies performed in our system over a one year period. The operating room supply costs and procedure durations were obtained for each of the hospitals. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) outcomes and demographics were compared to the costs for each hospital.
Results: During the study period 7792 laparoscopic cholecystectomies were performed at 22 hospitals (39 to 759 per hospital). The average cost per case ranged from $296 at the lowest cost center to $658 at the highest cost center. The average operative time varied between sites from 56 to 95 minutes. There was no association between lower cost and longer operative time, although sites with rotating surgical residents took on average 15 minutes longer than sites with no trainees. The patient demographics and comorbidities were similar between sites. There were no significant differences in postoperative complications between high and low cost centers. The items with the greatest increase in cost were disposable trocars, disposable hook cautery, disposable endoscissors, and disposable clip appliers. We estimate that a savings of over $300 per case is possible by using reusable instruments, which would result in an annual savings of over $100,000 per hospital.
Conclusion: Performing laparoscopic cholecystectomy with reusable instruments can significantly decrease costs, and does not increase operative time or postoperative complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86274
Program Number: S009
Presentation Session: Outcomes/Quality Session
Presentation Type: Podium