LAPAROSCOPIC CHOLECYSTECTOMY-RELATED BILE-DUCT INJURIES - A HEALTH AND FINANCIAL DISASTER

Objective This study was designed to evaluate the total costs associat ed with repair of laparoscopic cholecystectomy (LC)-related bile duct injuries. Summary Background Data The popularity of LC with both patie nts and surgeons is such that this procedure now exceeds open cholecys tectomy by a ratio of approximately 4 to 10:1. However, costs associat ed with LC-related injuries, particularly regarding treatment patterns , have up to now not been explored fully. Methods The complete hospita l and interventional radiology (IR) billing records for 49 patients wh o have completed treatment for laparoscopic cholecystectomy-related bi le duct injuries were divided into 8 categories. These records were to taled for comparison of costs between patient groups that experienced different injuries and treatment patterns. Results Patients with LC-re lated bile duct injuries were billed a mean of $51,411 for all care re lated to repair of their bile duct injury. Patients incurred an averag e of 32 days of inpatient hospitalization and 10 outpatient care days. Postoperative treatment included long-term chronic biliary intubation averaging 378 days. Two patients (4%) died as a result of their LC-re lated complications. Patients with bile duct injuries that were recogn ized immediately at the time of the initial surgery ultimately experie nced a total cost for their repair and hospitalization of 43% to 83% l ess than for patients in whom recognition of the injury was delayed (p < 0.019 to 0.070). In addition, the total hospitalization and outpati ent care days was reduced by as much as 76% with early recognition of an iatrogenic injury. Conclusions Repair of cholecystectomy-related bi le duct injuries can run 4.5 to 26.0 times the cost of the uncomplicat ed procedure and carries a significant mortality rate. intraoperative recognition of such an injury with immediate conversion to an open pro cedure for definitive repair can result in significant cost savings an d relates directly to a decreased morbidity, mortality, length of hosp italization, and number of outpatient care days.