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Biliary migration treated with ERCP alone carries an increased risk ok recurrent biliary event compared to cholecystectomy. It is our impression that delayed gallbladder removal also imposes additionnal costs to healthcare.
Charts from1600 patients with a primary diagnosis of biliary migration, cholangitis, biliary pancreatitis or gallstone-related obstructive jaundice event between 1994 and 2008 in a single community-based teaching hospital were reviewed. Minor aged patients, one-day elective surgery at the first diagnosis of a biliary event and excessive lenght of stay were excluded.The costs of hospital care was calculated using consultation fees, procedure costs, hospital stay and clinical support related costs. Totals costs related to the biliary event when the cholecystectomy was performed at the initial event were compared to the total health care costs of postponed cholecystectomy.
Surprisingly, biliary event-related costs of initial cholecystectomy (\ 15 531.53) was slightly higher (but non-significantly) than later cholecystectomy (\ 14 822,70), even when readmission and ERCP occured inbetween for recurrent biliary complication. This unsuspected twist may be driven by the longer lenght of stay during the initial event caused by delays related to imaging, ERCP and other tests done before the surgery. It is possible that in a different health care setting where procedural costs are much higher, the economic weight of late cholecystectomy would have leaned if favor of faster access to surgery.
Readmission for new biliary complication occured significantly more often during the lenght of the study when cholecystectomy was delayed (17%) compared with initial cholecystectomy (7.5%), imposing unnecessary inconvenience to patients and increased technical and human burden to the health care system. Late cholecystectomy does not seem to impose additionnal costs over first episode cholecystectomy in Quebec health care system but is associated with increased admission for relapsing biliary events.