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Costs of laparoscopic cholecystectomy

Analysis of potential savings

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Abstract

Despite the growing acceptance of laparoscopic cholecystectomy the costs remain unclear. Therefore, a detailed cost analysis was performed to determine potential savings. As part of a continuing audit, data of 508 consecutive laparoscopic cholecystectomies have been prospectively collected. Pre-, intra-, and postoperative variables were assessed by standardized questionnaires. These data were used to estimate the average use of diagnostics, drug consumption, operation time, and hospital stay. In addition, costs for loss in income, “hotel services,” diagnostic procedures, and for the operation itself were calculated in detail.

The total costs for a standard laparoscopic cholecystectomy were 3,395 deutsche marks (DM). The costs for the operation itself represented 19%, “hotel services” and medical treatment except the operation such as nursing, visits, or diagnostic procedures represented 47%, and the loss of income another 33% of the total costs. Thus, most effective savings may be achieved by shortening the hospital stay and the time of inability to work. However, each additional 30 min of operating time costed 146 DM (4.88 DM/min) and an “ideal” operation performed within 40 min and with a 3-day hospital stay would save 20% of the total and 31% of the hospital costs. An increase in the number of operations per year would not have a relevant impact on the cost.

Disposable instruments would have increased the costs by 1,118 DM (33%). The costs for cleaning, packing, and disposal were only marginal. Reusable instruments were not related to any disadvantage either to the patients or to the staff. No injuries of the staff caused by these instruments were observed. A potential prevention of all wound infections that had occurred in the present series (n=10) by disposable instruments would have cost an additional 541,844 DM or 54,184 DM per infection prevented. In conclusion, disposable instruments are not cost-effective.

The results of this study may contribute to further significant cost savings of laparoscopic cholecystectomy.

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Authors and Affiliations

  1. Surgical Clinic, II. Department of Surgery, University of Cologne, Ostmerheimerstrasse 200, 51109, Köln, Germany

    B. M. Ure & H. Troidl

  2. Biochemical and Experimental Division, II. Department of Surgery, University of Cologne, Ostmerheimerstrasse 200, 51109, Köln, Germany

    R. Lefering

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  1. B. M. Ure
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  2. R. Lefering
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  3. H. Troidl
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Ure, B.M., Lefering, R. & Troidl, H. Costs of laparoscopic cholecystectomy. Surg Endosc 9, 401–406 (1995). https://doi.org/10.1007/BF00187159

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  • DOI: https://doi.org/10.1007/BF00187159

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