P. P. Patel1, J. M. Velasco1 1Northshore University Health System,Skokie, IL, USA
Introduction:
Early laparoscopic cholecystectomy (LC) for acute cholecystitis in the elderly has proven to be safe, however it has not been universally adopted. In spite of published guidelines, percutaneous cholecystostomy or delayed LC with antibiotic treatment has been increasingly utilized as the initial step in the management of these patients. In this era of fiscal scrutiny, specific cost benefits of early LC have not been well examined, particularly in the elderly. This study examines whether early LC in the elderly results in efficient and effective care when compared to alternative management approaches.
Methods:
A retrospective chart review of patients admitted to a four-hospital single university affiliated health system from January 1, 2009 to December 31, 2011 was completed. Patients older than 65 with histologically documented acute cholecystitis were selected. Eligible patients (237) were distributed into three groups based on initial treatment of cholecystitis: early LC within 7 days, delayed LC, or percutaneous cholecystostomy. Patient charges, including diagnostic tests, pharmacy and consultation fees, length of stay, and number of hospital admissions were compared between groups. Statistical analysis was completed by ANOVA allowing comparison of the means of the three patient groups.
Results:
Patients who underwent an early LC had an average LOS just over six days totalling appoximately $50,000 in charges, while those who had delayed cholecystectomies were admitted for two days longer with charges totalling approximately $70,000. The percutaneous group had stays significantly longer averaging two weeks with charges totalling over $100,000. Patients who underwent a delayed management strategy had a higher rate of recurrent events, requiring more interventions that resulted in a statistically significant cost increase.
Conclusion:
Early laparoscopic cholecystectomy completed within 7 days of presention is the most cost-effective treatment for acute cholecystitis in the elderly.
