ESTIMATED COSTS OF BILIARY-TRACT COMPLICATIONS IN LAPAROSCOPIC CHOLECYSTECTOMY BASED UPON MEDICARE COST CHARGE RATIOS - A CASE-CONTROL STUDY/

Background: Costs of laparoscopic cholecystectomy (LC)associated bilia ry tract complications are poorly documented. Methods: A retrospective , case-controlled study attempted to define costs in an institution-sp ecific manner, as compared to a group of patients who underwent an unc omplicated LC at the same institution. Costs were estimated by obtaini ng actual hospital billing charges and multiplying them by each hospit al's specific Medicare cost-to-charge ratio (MCCR). This is considered a reasonable estimate of cost. The MCCR is calculated annually and is the hospital's actual cost estimate divided by what it charges. Resul ts: Twelve complications consisting of six common bile duct transectio n/excisions (CBDTE), one CBD leak/stricture (CBDLS), and five cystic d uct leaks (CDL) were identified and matched to a control group (having an uncomplicated LC) for age, sex, and institution where the LC had b een completed. Mean cost for CBDTE was $9,061 +/- $5,112 vs $2,689 +/- $1,469 for controls (p = 0.015), and $6,937 +/- $3,317 for CDL vs the controls cost of $1,343 +/- $417 (p = 0.006). The single CBDLS injury cost $5,804 vs $3,611 for the control. While the costs of these compl ications are statistically significantly greater than the controls, th ey are dramatically less than the costs reported in the literature for these problems ($30,000-$300,000). Conclusions: Costs of LC-associate d biliary tract complications, as calculated using MCCR multiplied by hospital charges, for each complication type were statistically signif icantly higher than for the control groups. Although more expensive th an the controls, these complications do not appear to be as costly as has been reported in the past.