title: Analysis of actual healthcare costs of early versus interval cholecystectomy in acute cholecystitis.
abstract: BACKGROUND
  Healthcare cost modeling have favored early (ELC) over interval laparoscopic cholecystectomy (ILC) for acute cholecystitis (AC). However, actual costs of treatment have never been studied. The aim of the present study was to compare actual hospital costs involved in ELC and ILC in patients with AC.
  
  
  METHODS
  Retrospective study of patients who underwent laparoscopic cholecystectomy for AC was conducted. Demographic, clinical, operative data and costs were extracted and analyzed.
  
  
  RESULTS
  Between 2011 and 2013, 201 had laparoscopic surgery for AC at Tan Tock Seng Hospital, Singapore. One hundred and thirty-four (67%) patients underwent ELC (≤7 days of presentation, within index admission). Median total length of stay (LOS) was 4.6 and 6.8 days for ELC and ILC groups, respectively (P = 0.006). Patients who had ELC also had significantly lesser total number of admissions (P < 0.001). The median (IQR) total inpatient costs were €4.4 × 10(3) (3.6-5.6) and €5.5 × 10(3) (4.0-7.5) for ELC and ILC patients, respectively (P < 0.007). Costs associated with investigations were significantly higher in the ILC group (P = 0.039), of which serological costs made most difference (P < 0.005). The ward costs were also significantly higher in the ILC group.
  
  
  CONCLUSIONS
  The cost differences reflect the significantly increased total LOS, and repeat presentations associated with ILC. Therefore, ELC should be the preferred management strategy for AC.
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, Annex 1, 11 Jalan Tan Tock Seng, Singapore, 308433; School of Medicine, University of Aberdeen, Aberdeen, Scotland.
authors.forename: Cheryl H M
authors.initials: CH
authors.lastname: Tan
authors.forename: Tony C Y
authors.initials: TC
authors.lastname: Pang
authors.forename: Winston W L
authors.initials: WW
authors.lastname: Woon
authors.forename: Jee Keem
authors.initials: JK
authors.lastname: Low
authors.forename: Sameer P
authors.initials: SP
authors.lastname: Junnarkar
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000191:economics*; D041881:Cholecystitis, Acute / Q000191:economics* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012846:Singapore; D013997:Time Factors
keywords: Acute calculous cholecystitis; Early laparoscopic cholecystectomy; Interval laparoscopic cholecystectomy