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 biliary tract complications are poorly documented.


METHODS
A retrospective, case-controlled study attempted to define costs in an institution-specific manner, as compared to a group of patients who underwent an uncomplicated LC at the same institution. Costs were estimated by obtaining actual hospital billing charges and multiplying them by each hospital'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.


RESULTS
Twelve complications consisting of six common bile duct transection/excisions (CBDTE), one CBD leak/stricture (CBDLS), and five cystic duct leaks (CDL) were identified and matched to a control group (having an uncomplicated LC) for age, sex, and institution where the LC had been 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 complications are statistically significantly greater than the controls, they are dramatically less than the costs reported in the literature for these problems ($30,000-$300,000).


CONCLUSIONS
Costs of LC-associated biliary tract complications, as calculated using MCCR multiplied by hospital charges, for each complication type were statistically significantly higher than for the control groups. Although more expensive than the controls, these complications do not appear to be as costly as has been reported in the past.
Woods
M S
MS
Division of Gastroenterology, Janssen Research Foundation, 1125 Trenton-Harbourton Road, Titusville, NJ 08560-0200, USA.
D016022:Case-Control Studies; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics*; D014481:United States