Costs and utilization of intraoperative cholangiography.
BACKGROUND
Routine intraoperative cholangiography (IOC) has been advocated as a viable strategy to reduce common bile duct injury (CDI) during cholecystectomy. This is predicated, in part, on the low cost of IOC, making it a cost-effective preventive strategy. Using billed hospital charges as a proxy for costs, we sought to estimate costs associated with the performance of IOC.


METHODS
The 2001 National Inpatient Survey (NIS) database was assessed for IOC utilization and associated charges. Average charges for hospital admission where the primary procedure was laparoscopic cholecystectomy were compared for those associated with and without the performance of IOC.


RESULTS
Eighteen percent of cholecystectomies were performed in facilities that never perform IOC. Routine IOC (defined as >75% of cholecystectomies performed in any one hospital having a concomitant IOC) was performed in only 11% of hospitals. In the remaining 71% of hospitals, selective IOC was performed. IOCs were associated with US $706-739 in additional hospital charges when performed in conjunction with laparoscopic cholecystectomy. We project a cost of US $371,356 to prevent a single bile duct injury by using routine cholangiography.


CONCLUSIONS
We conclude that only a minority of hospitals performs cholecystectomies with routine IOC. Because of the significant amount of hospital charges attributable to IOC, routine IOC is not cost-effective as a preventative measure against bile duct injury during cholecystectomy.
Livingston
Edward H
EH
Division of Gastrointestinal and Endocrine Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9156, USA. edward.livingston@utsouthwestern.edu
Miller
Jordan A G
JA
Coan
Brian
B
Rege
Robert V
RV
D000328:Adult; D002758:Cholangiography / Q000191:economics* / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D002769:Cholelithiasis / Q000191:economics / Q000601:surgery; D003135:Common Bile Duct / Q000293:injuries; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D005705:Gallbladder Diseases / Q000191:economics / Q000601:surgery; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D014481:United States