Financial Burden Secondary to Delay in Cholecystectomy Following Mild Biliary Pancreatitis.
OBJECTIVE
The guidelines recommend that patients with mild gallstones pancreatitis should undergo a definitive management for gallstones during the same admission or within the next two weeks. The aim of this study was to estimate the financial cost resulting from a delay in surgical management following mild gallstones pancreatitis. This includes the costs of readmissions with biliary events and the subsequent investigations required during these admissions.


METHODS
A retrospective analysis included patients with gallstone pancreatitis who were admitted to a district general hospital in the United Kingdom over one year. Patients with severe pancreatitis and those unfit for surgery were excluded.


RESULTS
Forty patients were included in the study, 27 females (67%) and 13 males (33%). Mean age was 50.2 years. Twenty-two patients of the total presented with a single admission with gallstone pancreatitis prior to an elective surgery; however, 18 patients (45%) required recurrent admissions. The duration between the first admission and surgery ranged from 14 to 389 days (median of 99 days). Only one patient (2.5%) had cholecystectomy within two weeks of admission as per guidelines. Twenty-two ultrasound scans, four computed tomography scans, 15 magnetic resonance cholangiopancreatography, and two endoscopic retrograde cholangiopancreatography were the total of the extra-investigations required during readmissions. Estimated costs of extra admissions and extra investigations exceeded £33,000.


CONCLUSIONS
The delay in cholecystectomy for patients admitted with mild gallstone pancreatitis and fit for surgery has resulted in high readmission rate with biliary events, and subsequently high extrax costs.
a Department of General Surgery , Queen Elizabeth the Queen Mother Hospital , St. Peter's Road, Margate, Kent , UK.|b Department of General Surgery , Ain Shams University Hospital , Ramses Street, Abbassia, Cairo , Egypt.
Mohamed H
MH
Boshnaq
a Department of General Surgery , Queen Elizabeth the Queen Mother Hospital , St. Peter's Road, Margate, Kent , UK.
Nabeel
N
Merali
a Department of General Surgery , Queen Elizabeth the Queen Mother Hospital , St. Peter's Road, Margate, Kent , UK.|b Department of General Surgery , Ain Shams University Hospital , Ramses Street, Abbassia, Cairo , Egypt.
Islam H
IH
El Abbassy
a Department of General Surgery , Queen Elizabeth the Queen Mother Hospital , St. Peter's Road, Margate, Kent , UK.|b Department of General Surgery , Ain Shams University Hospital , Ramses Street, Abbassia, Cairo , Egypt.
Sayed A
SA
Eldesouky
a Department of General Surgery , Queen Elizabeth the Queen Mother Hospital , St. Peter's Road, Margate, Kent , UK.|b Department of General Surgery , Ain Shams University Hospital , Ramses Street, Abbassia, Cairo , Egypt.
Mohamed A
MA
Rabie
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000191:economics* / Q000601:surgery; D010359:Patient Readmission / Q000191:economics*; D012189:Retrospective Studies; D055815:Young Adult
biliary colic; cholecystectomy; gallstones; pancreatitis