Two-week target for laparoscopic cholecystectomy following gallstone pancreatitis is achievable and cost neutral.
BACKGROUND
The British Society of Gastroenterology recommends that all patients with gallstone pancreatitis should undergo cholecystectomy within 2 weeks. This study assessed whether these guidelines are feasible and cost-effective.


METHODS
Admissions for gallstone pancreatitis between January 2006 and January 2008 were reviewed. Readmissions for subsequent pancreatitis or biliary pathology were noted together with additional investigations, severity scores, hospital stay and time to cholecystectomy. The costs of readmission and theoretical costs of developing a dedicated operating list were provided by independent accountants.


RESULTS
During the 2 years, 153 patients were admitted. Twenty-one patients (13.7 per cent) had further attacks requiring 40 readmissions. There were no deaths. Additional hospital costs related to readmissions were 172,170 pound sterling, including bed occupancy (67,860 pound sterling), investigations (12,510 pound sterling) and 153 cholecystectomies on an existing theatre list (91,800 pound sterling). The estimated cost of staffing a half-day theatre list every fortnight, performing 153 cholecystectomies, was 170,391 pound sterling.


CONCLUSIONS
Instigating a dedicated theatre for cholecystectomy after biliary pancreatitis has many potential benefits. The costs of readmissions and ad hoc operating are balanced by those of a dedicated theatre list in the long term. Implementation of the guidelines would save approximately 900 pound sterling annually and be cost neutral.
Monkhouse
S J W
SJ
Department of General Surgery, Great Western Hospital, Swindon SN3 6BB, UK.
Court
E L
EL
Dash
I
I
Coombs
N J
NJ
D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000191:economics*; D003362:Cost-Benefit Analysis; D004812:Epidemiologic Methods; D042882:Gallstones / Q000150:complications / Q000191:economics* / Q000601:surgery; D019983:Guideline Adherence / Q000191:economics; D006801:Humans; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications / Q000191:economics* / Q000601:surgery; D010359:Patient Readmission / Q000191:economics; D012720:Severity of Illness Index; D013997:Time Factors