Is intraoperative cholangiography during laparoscopic cholecystectomy cost effective?
BACKGROUND
Common bile duct injuries occur in 0.2% to 0.8% of laparoscopic cholecystectomies (LC). Intraoperative cholangiograms (IOCG) are a useful means of detecting common bile duct injuries in the operating room.


METHODS
Data were retrospectively reviewed for patients referred for management of common duct injuries from 1996 to 2000. Cost data were obtained from hospital records. Legal settlements were obtained from published sources.


RESULTS
Twenty-one patients (0.133%) were found to have bile duct injuries and incurred median hospital stays of 11.5 days at an average cost of $587,491. The average cost of those requiring reoperation was $669,134. The 21 cases in our sample had total charges of $10,819,767. Performing IOCG during each LC in Orange County would have cost $10,669,725. If extrapolated to state and nationwide levels, the savings is far greater.


CONCLUSIONS
IOCG during LC is a cost-effective means of preventing the costs of delayed recognition of bile duct injuries.
Podnos
Y D
YD
Department of Surgery, Division of Transplantation, University of California, Irvine Medical Center, Bldg. 26, Rm. 1001, 101 The City Dr., Orange, CA 92868, USA.
Gelfand
D V
DV
Dulkanchainun
T S
TS
Wilson
S E
SE
Cao
S
S
Ji
P
P
Ortiz
J A
JA
Imagawa
D K
DK
D000328:Adult; D002758:Cholangiography / Q000191:economics*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003135:Common Bile Duct / Q000293:injuries; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000191:economics*; D012086:Reoperation / Q000191:economics; D012189:Retrospective Studies; D014481:United States