title: Impact of timing of bile duct interventions on resource use and clinical outcome of cholecystectomy patients in Japan.
abstract: OBJECTIVE
  Laparoscopic cholecystectomy (LC) is increasingly used for acute cholecystitis, in conjunction with staged bile duct interventions (BDIs). However, few studies have evaluated the impact of BDI timing on costs and clinical outcomes during hospitalization. This study assessed the effects of several types of BDI and their timing on resource utilization and complications.
  
  
  METHODS
  A total of 13,738 cholecystectomy patients were treated for benign gallbladder diseases in 66 academic and 376 community hospitals in Japan in 2006. Variables analysed included: BDIs including endoscopic retrograde cholangiopancreatography (ERCP), percutaneous gallbladder or common bile duct drainage (external drainage), endoscopic sphincterotomy, clearance of choledocholithiasis (internal drainage); and length of stay (LOS), total charges (TCs), procedure-related complications, and hospital function. Multivariate analysis was used to determine the impact of LC or BDIs on LOS, TCs and complications.
  
  
  RESULTS
  A total of 11,690 (85.1%) patients underwent LC. Inflammation was diagnosed in 70.7% of open cholecystectomy (OC) and 42.1% of LC patients. Complications were 7.7% in OC and 5.4% in LC patients. LC was associated with reduced LOS and TCs. BDIs were performed in more OC than LC patients. Preoperative was more costly than postoperative ERCP. Postoperative external drainage was significantly associated with LOS, TCs and complications. Advantages of pre- or postoperative internal drainage were not proven.
  
  
  CONCLUSIONS
  External drainage should be completed preoperatively. Postoperative ERCP may be preferable for bile duct scrutiny alone. Further evaluation of the timing of cholecystectomy will determine precisely the superiority of pre- or postoperative BDIs in terms of quality of care for complicated patients.
authors.affiliation: Kyushu University, Graduate School of Medical Sciences, Department of Health Care Administration and Management, Fukuoka, Japan. kazu228@basil.ocn.ne.jp
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Kuwabara
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.forename: Koichi B
authors.initials: KB
authors.lastname: Ishikawa
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Kenshi
authors.initials: K
authors.lastname: Hayashida
authors.forename: Kenji
authors.initials: K
authors.lastname: Fujimori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D013997:Time Factors