title: An economic analysis of hospital charges for choledocholithiasis by different treatment strategies.
abstract: The ideal management of presumed choledocholithiasis is controversial. We hypothesized that patients admitted with presumed choledocholithiasis would be better served financially to undergo laparoscopic cholecystectomy (LC) with possible intraoperative intervention versus preoperative endoscopic retrograde cholangiopancreatography followed by LC. A chart review was performed from September 1, 2000 to August 31, 2003. One hundred seventy-one consecutive patients identified with presumed choledocholithiasis were reviewed. Six patients were excluded because of missing charge data. Professional and technical fees from the total hospital charges were used for comparison. Three groups of patients were compared for charge analysis. Group 1 underwent LC with laparoscopic common bile duct exploration. Group 2 underwent LC with preoperative or postoperative endoscopic retrograde cholangiopancreatography. Group 3 was a control group of LC only. Student's t test was used for statistical analysis with a P value of <0.05 defined as statistically significant. P values reflect comparisons with Group 1. Group 1 charges were $13,026, Group 2 charges were $15,303, and Group 3 charges were $9,122. For suspected choledocholithiasis, LC with intraoperative intervention is the most economically advantageous approach.
authors.affiliation: Gundersen Lutheran Medical Center, Department of General and Vascular Surgery, La Crosse, Wisconsin 54601, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Schroeppel
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Lambert
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Mathiason
authors.forename: Shanu N
authors.initials: SN
authors.lastname: Kothari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000191:economics*; D017081:Cholecystectomy, Laparoscopic / Q000191:economics* / Q000379:methods*; D042883:Choledocholithiasis / Q000175:diagnosis* / Q000191:economics / Q000601:surgery*; D003135:Common Bile Duct / Q000473:pathology; D003362:Cost-Benefit Analysis; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies