FINANCIAL COST TO INSTITUTIONS ON PATIENTS WAITING FOR GALL BLADDER DISEASE SURGERY

Authors

  • Ahmed Waqas
  • Shahzad Ahmed Qasmi
  • Faran Kiani
  • Ahmed Raza
  • Khizar Ishtiaque Khan
  • Shazia Manzoor

Abstract

Background: The aim of this study was to determine the financial costs to institution on patients waiting for gall bladder disease surgery and suggest measures to reduce them. Methods: This multi-centre prospective descriptive survey was performed on all patients who underwent an elective cholecystectomy by three consultants at secondary care hospitals in Pakistan between Jan 2010 to Jan 2012. Data was collected on demographics, the duration of mean waiting time, specific indications and nature of disease for including the patients in the waiting list, details of emergency re-admissions while awaiting surgery, investigations done, treatment given and expenditures incurred on them during these episodes. Results: A total of 185 patients underwent elective open cholecystectomy. The indications for listing the patients for surgery were biliary colic in 128 patients (69%), acute cholecystitis in 43 patients (23%), obstructive jaundice in 8 patients (4.5%) and acute pancreatitis in 6 patients (3.2%). 146 (78.9%) and 39 (21.1%) of patients were listed as outdoor electives and indoor emergencies respectively. Of the 185 patients, 54 patients (29.2%) were re-admitted. Financial costs in Pakistani rupees per episode of readmission were 23050 per episode in total and total money spent on all readmissions was Rs. 17,05,700/-. Conclusion: Financial costs on health care institutions due to readmissions in patients waiting for gall bladder disease surgery are high. Identifying patients at risk for these readmissions and offering them early laparoscopic cholecystectomy is very important.Keywords: Diseases, gall bladder, cholecystitis, gall stones, patient readmission, health care costs

References

Al-Mulhim AA. Timing of early laparoscopic cholecystectomy for acute cholecystitis. JSLS 2008;12:282–7.

Cameron IC, Chadwick C, Phillips J, Johnson AG. Acute cholecystitis-room for improvement? Ann R Coll Surg Engl 2002;84(1):10–3.

Cheruvu CV, Eyre-Brook IA. Consequences of prolonged wait before gallbladder surgery. Ann R Coll Surg Engl 2002;84(1):20–2.

Pay and Allowances Regulations (VI-II), Chapter VII Recoveries and Stoppages. Pakistan: Ministry of Defence, Defence Division; 2012.

Shibuya K, Hashimoto H, Ikegami N, Nishi A, Tanimoto T, Miyata H, et al. Future of Japan's system of good health at low cost with equity: beyond universal coverage. Lancet 2011;378:1265–73.

Zook CJ, Moore FD. High-cost users of medical care. N Engl J Med 1980;302:996–1002.

Benbassat J, Taragin M. Hospital readmissions as a measure of quality of health care: advantages and limitations. Arch Intern Med 2000;160:1074–81.

Schiøtz M, Price M, Frølich A, Søgaard J, Kristensen JK, Krasnik A, et al. Something is amiss in Denmark: A comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente. BMC Health Serv Res 2011;11(1):347.

Veronesi JF. Management Topics: How Accountable Care Will Impact Home Health Agencies. Home Health Care Manag Pract 2011;23(2):139–41.

Horwitz L, Partovian C, Lin Z, Herrin J, Grady J, Conover M, et al. Hospital-wide (all-condition) 30-day risk-standardized readmission measure. 2011. Available at: http://www.cms.gov/MMS/Downloads/MMSHospital- WideAllConditionReadmisionRate.pdf

Clarke M, Wheatley T, Hill M, Werrett G, Sanders G. An Effective Approach to Improving Day-Case Rates following Laparoscopic Cholecystectomy. Minim Invasive Surg 2011;2011:564587.

Kaman L, Iqbal J, Bukhal I, Dahiya D, Singh R. Day Care Laparoscopic Cholecystectomy: Next Standard of Care for Gall Stone Disease. Gastroenterol Res 2011;4:257–61

Downloads

Published

2014-06-01