EMERGENCY LAPAROSCOPIC CHOLECYSTECTOMY: IS DEDICATED HOT GALL BLADDER LIST COST EFFECTIVE?

Saad Ullah Khan, Jun Yi Soh, Nazli Muhibullah, Aikaterini Peleki, Muhammad Abdullah, Peter William Waterland

Abstract


Background: Acute presentation of gall stone disease is a common emergency. Resource limitation often results in unnecessary long waiting times and repeat hospital admissions. The aim of this study was to investigate if funding a dedicated hot gall bladder list is justified. Methods: Patients with acute gall stone related complications between 1st January 2016 and 31st December 2017 were studied. Outcome measures included the number of acute admissions, length of hospital stay (LOS), approximate cost per patient. The length of stay was identified as a critical outcome measure. Results: Fourteen hundred and ninety-five (11%) out of 14189 acute surgical admissions were related to gall stone complications. These included acute cholecystitis 576 (39%), biliary colic 485 (32%), pancreatitis 405 (27%) and jaundice 34 (2%). Twelve hundred and twenty-two patients accounted for 1461 admissions. 182 (15%) patients had recurrent admissions (35%) and on average stayed 11.2 days in the hospital compared to 5.8 days for that of single presentation. The cost of emergency LC (£2053) was less than half of elective LC following single emergency admission (£5661) and less than one third of Elective LC following recurrent admissions (£7453). A trust can save £1,891,784 per year by achieving 80% target. The savings can be used to fund a dedicated hot gall bladder list, releasing hospital beds and additional benefit of reducing the workforce days lost to sickness in general. Conclusion: Emergency LC is cost effective and savings made for such a service is sufficient to fund a dedicated hot gall bladder list.

Keywords: Laparoscopic; Cholecystectomy; Laparoscopic cholecystectomy; Cost-Benefit Analysis; Hospital Costs; Cost Savings; Costs and Cost Analysis

Full Text:

PDF

References


National Institute of Health and Care Excellence. Gallstone disease: diagnosis and management: Clinical guideline. [Internet]. 2014 [cited 2018 May 30]. Available from: https://www.nice.org.uk/guidance/cg188/chapter/1-Recommendations#diagnosing-gallstone-disease

Papi C, Catarci M, D’Ambrosio L, Gili L, Koch M, Grassi GB, et al. Timing of cholecystectomy for acute cholecystitis: a meta-analysis. Am J Gastrointerol 2004;99(1):147–55.

National Institute for Health and Care Excellence, Gallstone disease: Quality standard. [Internet]. 2015 [cited 2018 Jun 9]. Available from: https://www.nice.org.uk/guidance/qs104

Pathway for the Management of Acute Gallstone Diseases. [Internet]. 2015 [cited 2018 May 15]. Available from: http://www.augis.org/wp-content/uploads/2014/05/Acute-Gallstones-Pathway-Final-Sept-2015.pdf

Besselink M, van Santvoort H, Freeman M, Gardner T, Mayerle J, Vege SS, et al. IAP/APA evidence-based guidelines for the management of acute pancreatitis guideline. Pancreatology 2013;13(4, suppl 2):E1–15.

Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson BR. Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 2010;97(2):141–50.

Lu J, Cheng Y, Xiong XZ, Lin YX, Wu SJ, Cheng NS. Two-stage vs single-stage management for concomitant gallstones and common bile duct stones. World J Gastroenterol 2012;18(24):3156–66.

Kerwat D, Zargaran A, Bharamgoudar R, Arif N, Bello G, Sharma B, et al. Early laparoscopic cholecystectomy is more cost-effective than delayed laparoscopic cholecystectomy in the treatment of acute cholecystitis. Clinicoecon Outcomes Res 2018;10:119–25.

Gurusamy KS, Samraj K. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Cochrane Database Syst Rev 2006;18(4):CD005440.

National Health Service. Choices: your health, your choices. Gallbladder surgery. [Internet]. 2018 [cited 2018 May 28]. Available from: https://www.nhs.uk/service-search/Gallbladder-surgery/dy12lu/Results/373/-2.11953806877136/52.5042877197266/1370/0?distance=25

National Health Service reference costs 2015 to 2016 - GOV.UK [Internet]. [cited 2018 May 29]. Available from: https://www.gov.uk/government/publications/nhs-reference-costs-2015-to-2016

NHS, Institute for Innovation and improvement. Improving quality and efficiency in the operating theatre - a lifeline for financial leaders. [Internet]. 2009 [cited 2018 Jun 30]. Available from: http://harmfreecare.org/wp-content/files_mf/Improving-quality-and-efficiency-in-the-operating-theatre.pdf

BMA - Pay scales for consultants in England 2017-18. [Internet]. [cited 2018 May 29]. Available from: https://www.bma.org.uk/advice/employment/pay/consultants-pay-england

BMA - Pay scales and guidance for medical academics. [Internet]. [cited 2018 May 29]. Available from: https://www.bma.org.uk/advice/employment/pay/medical-academics-pay

Royal college of Nursing. National Health Service Pay scale 2017-18. [Internet]. [cited 2018 July 2]. Available from: https://www.rcn.org.uk/employment-and-pay/nhs-pay-scales-2017-18

Gurusamy KS, Nagendran M, Davidson BR. Early versus delayed laparoscopic cholecystectomy for acute gallstone pancreatitis. Cochrane Database Syst Rev 2013;(9):CD010326.

Nuffieldtrust, Evidence for better health care. Emergency general surgery: challenges and opportunities. [Internet]. 2016 [cited 2018 May 10]. Available from: http://www.nuffieldtrust.org.uk/publications/emergency-general-surgery-challenges-and-opportunities

Royal College of Surgeons. Cholecystectomy Quality Improvement Collaborative (Chole-QuIC) [Internet]. [cited 2018 Jun 10]. Available from: https://www.rcseng.ac.uk/standards-and-research/standards-and-guidance/service-standards/emergency-surgery/cholecystectomy-quality-improvement-collaborative/


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]