title: [Minimising hospital costs in the treatment of bile duct calculi: a comparison study].
abstract: BACKGROUND
  The treatment of bile duct calculi associated with cholelithiasis is controversial. The hospital costs could be a decisive factor in choosing between the different therapeutic options.
  
  
  OBJECTIVE
  To compare the effectiveness and costs of two options in the treatment of common bile duct calculi: 1) One-stage: Laparoscopic cholecystectomy and bile duct exploration, and 2) Two-stage: sequential endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy.
  
  
  METHODS
  A retrospective, observational study was performed on 49 consecutive patients with bile duct calculi and gallbladder in situ, treated consecutively and simultaneously over a two year period. The post-operate complication, hospital stay, number of procedures per patient, conversion to laparotomy, efficacy of removing the calculi, and hospital costs.
  
  
  RESULTS
  There were no differences as regards the patient clinical features or morbidity. The mean post-surgical hospital stay for the One-stage group was less than that in the Two-stage group. Three patients of the Two-stage group required conversion to laparotomy. The median costs per patient were less for the One-stage strategy, representing an overall saving of 37,173€ during the period studied.
  
  
  CONCLUSIONS
  No significant differences were found between the two treatment options as regards efficacy or post-surgical morbidity and mortality, but there were differences in hospital stay and costs. The management of patients with gallstones in one-stage surgery represents a saving of 3 days hospital stay and 1,008€ per patient.
authors.affiliation: Servicio de Cirugía General y Aparato Digestivo, Consorci Sanitari Integral, L'Hospitalet del Llobregat, Barcelona, España. 24271rjm@comb.cat
authors.forename: Rosa
authors.initials: R
authors.lastname: Jorba Martín
authors.forename: Elena
authors.initials: E
authors.lastname: Ramirez Maldonado
authors.forename: Joan
authors.initials: J
authors.lastname: Fabregat Prous
authors.forename: Dolors
authors.initials: D
authors.lastname: Buisac González
authors.forename: Marta
authors.initials: M
authors.lastname: Banqué Navarro
authors.forename: Joan
authors.initials: J
authors.lastname: Gornals Soler
authors.forename: Juli
authors.initials: J
authors.lastname: Busquets Barenys
authors.forename: Emilio
authors.initials: E
authors.lastname: Ramos Rubio
authors.forename: Núria
authors.initials: N
authors.lastname: Peláez Serra
authors.forename: Laura
authors.initials: L
authors.lastname: Lladó Garriga
authors.forename: Antoni
authors.initials: A
authors.lastname: Rafecas Renau
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000191:economics*; D017081:Cholecystectomy, Laparoscopic / Q000191:economics*; D005260:Female; D042882:Gallstones / Q000191:economics* / Q000601:surgery*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies