title: Costs and clinical outcomes of conventional single port and micro-laparoscopic cholecystectomy.
abstract: OBJECTIVE
  This study compares hospital costs and clinical outcomes for conventional laparoscopic, single-port, and mini-laparoscopic cholecystectomy from US hospitals.
  
  
  METHODS
  Eligible patients were aged ≥18 years and undergoing laparoscopic cholecystectomy with records in the Premier Hospital Database from 2009 through the second quarter of 2010. Patients were categorized into 3 groups-conventional laparoscopic, single port, or mini-laparoscopic-based on the International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes and hospital charge descriptions for surgical tools used. A procedure was considered mini-laparoscopic if no single-port surgery products were identified in the charge master descriptions and the patient record showed that at least 1 product measuring 5 mm was used, not more than 1 product measuring <5 mm was used, and the measurements of the other products identified equaled >5 mm. Summary statistics were generated for all 3 groups. Multivariable analyses were performed on hospital costs and clinical outcomes. Models were adjusted for demographics, patient severity, comorbid conditions, and hospital characteristics.
  
  
  RESULTS
  In the outpatient setting, for single-port surgery, hospital costs were approximately $834 more than those for mini-laparoscopic surgery and $964 more than those for conventional laparoscopic surgery (P < .0001). Adverse events were significantly higher (P < .0001) for single-port surgery compared with mini-laparoscopic surgery (95% confidence interval for odds ratio, 1.38-2.68) and single-port surgery versus conventional surgery (95% confidence interval for odds ratio, 1.37-2.35). Mini-laparoscopic surgery hospital costs were significantly (P < .0001) lower than the costs for conventional surgery by $211, and there were no significant differences in adverse events.
  
  
  CONCLUSIONS
  These findings should inform practice patterns, treatment guidelines, and payor policy in managing cholecystectomy patients.
authors.affiliation: Ethicon Endo-Surgery, Inc., Cincinnati, OH, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Chekan
authors.forename: Matthew
authors.initials: M
authors.lastname: Moore
authors.forename: Tina D
authors.initials: TD
authors.lastname: Hunter
authors.forename: Candace
authors.initials: C
authors.lastname: Gunnarsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000191:economics; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D015897:Comorbidity; D039702:Current Procedural Terminology; D004867:Equipment Design; D005260:Female; D005705:Gallbladder Diseases / Q000453:epidemiology; D017721:Hospital Costs; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016896:Treatment Outcome; D055815:Young Adult