Cost-effectiveness of same-admission <i>versus</i> interval cholecystectomy after mild gallstone pancreatitis in the PONCHO trial

Costa, David W da; Dijksman, Lea M.; Bouwense, Stefan; Schepers, Nicolien J.; Besselink, Marc G.; Santvoort, Hjalmar C. van; Boerma, Djamila; Gooszen, Hein G.; Dijkgraaf, Marcel G. W.

doi:10.1002/bjs.10222

Cited by 58 publications

(33 citation statements)

References 27 publications

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“…Figure 1 shows the modified PRISMA flowchart for identification and inclusion of relevant papers. Twentythree studies were excluded from the meta-analysis; 10 papers were deemed low quality [53][54][55][56][57][58][59][60][61] and 13 papers did not provide readmission rates specific to LC [62][63][64][65][66][67][68][69][70][71][72][73][74].…”

Section: Resultsmentioning

confidence: 99%

Readmission to hospital following laparoscopic cholecystectomy: a meta-analysis

McIntyre¹,

Johnston²,

Foley³

et al. 2020

ait

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Biliary disease and cholecystitis remain one of the most significant surgical challenges. Over 1,000,000 cholecystectomies are performed in the US every year [1, 2], and over 50,000 in the UK [3]. While minimally invasive laparoscopic cholecystectomy (LC) has afforded great advantages over open cholecystectomy, reducing variability and improving outcomes remains a challenge [4, 5]. It is only recently that operative classifications and grading of cholecystitis have been published [6]. LC related peri-operative complications, while infrequent may

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Section: Resultsmentioning

confidence: 99%

Readmission to hospital following laparoscopic cholecystectomy: a meta-analysis

McIntyre¹,

Johnston²,

Foley³

et al. 2020

ait

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“…However, da Costa and colleagues 29 have established the cost-effectiveness of their included RCT 24 . This demonstrated that EC was more cost-effective, with a mean total saving of €234 per patient 29 . Furthermore, Morris et al 30 demonstrated that laparoscopic cholecystectomy within 3 days of admission saves €795, with a 0⋅004 increment in quality-adjusted life-years.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis

Moody

Adiamah

Yanni

et al. 2019

British Journal of Surgery

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Background: Gallstones account for 30-50 per cent of all presentations of acute pancreatitis. While the management of acute pancreatitis is usually supportive, definitive treatment of gallstone pancreatitis is cholecystectomy. Guidelines from the British Society of Gastroenterology suggest definitive treatment on index admission or within 2 weeks of discharge, whereas joint recommendations from the International Association of Pancreatology and the American Pancreatic Association recommend definitive treatment on index admission. Evidence suggests that uptake of these guidelines is low.Methods: Embase, MEDLINE and Cochrane databases were searched for RCTs investigating early versus delayed cholecystectomy in patients with a confirmed diagnosis of mild gallstone pancreatitis. The pooled synthesis was undertaken using a random-effects meta-analysis of the primary outcome of recurrent biliary complications causing hospital readmission. Secondary outcomes included intraoperative and postoperative complications, and total length of hospital stay (LOS). All analyses were performed using RevMan5 software. Results: Five RCTs were identified, which included 629 patients (318 in the early cholecystectomy (EC) group and 311 in the delayed cholecystectomy (DC) group). Recurrent biliary events that required readmission were reduced in patients undergoing EC compared with the number in patients having DC(odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅09 to 0⋅33). There was no difference in the rate of intraoperative (OR 0⋅58, 0⋅17 to 1⋅92) or postoperative (OR 0⋅78, 0⋅38 to 1⋅62) complications.Conclusion: EC following mild gallstone pancreatitis does not increase the risk of intraoperative or postoperative complications, but reduces the readmission rate for recurrent biliary complications.

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“…8900, which is comparable with Da costa et al study. 16 In interval group readmission rate of 19% with no readmission in same admission group, comparable with International Surgery Journal | January 2020 | Vol 7 | Issue 1 Page 256 same admission cholecystectomy for mild gallstone pancreatitis has significant advantage of reducing recurrent gallstone pancreatitis. 17,18 The mean intra operative time in same admission group is 85min versus 92 min in interval group is comparable with Shir le jee et al 15 There was no conversion to open cholecystectomy in same admission group but in interval group 6.4% (2) had conversion to open surgery, because of dense adhesion and frozen calot's, due to which dissection was difficult, comparable with Johnstone et al 19 In both the groups there was no intraoperative and postoperative complication and is comparable with Aboulian et al 20 Data from the above study and also from other studies, it is found that the ideal timing for mild gallstone pancreatitis is same admission laparoscopic cholecystectomy over interval cholecystectomy by reducing the cost and duration of hospital stay, readmission due to recurrent pancreatitis.…”

Section: Discussionmentioning

confidence: 55%

The ideal timing of cholecystectomy for mild gallstone pancreatitis

Satishkumar

Anukethan

2019

Int Surg J

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Background: Gallstone disease is one of the most common problems affecting the digestive tract with a prevalence of 11% to 36% and is the most common cause of gall stone pancreatitis. The cholecystectomy is necessary to prevent recurrent pancreatitis in gallstone pancreatitis, but the ideal timing for cholecystectomy is controversial.Methods: This was a prospective randomized study with 59 patients conducted in the department of general surgery, KIMS, Bangalore from 2014 to 2019. All patient with mild gallstone pancreatitis, the following variables, duration and cost of hospital stay, readmission rates, intraoperative time, intra and postoperative complications and conversion to open cholecystectomy were studied.Results: A total of 59 patients in the age group of 21 to 71 years with mild gallstone pancreatitis were included in the study. Mean age of presentation was 57years. Out of 59 patients 28 underwent same admission cholecystectomy and 31 underwent interval cholecystectomy. There was a significant difference noted in terms of mean duration of hospital stay (9.28 versus 17.20 days), mean cost of hospital stay (19340 versus 28240rs) and readmission rate (0% versus 19.35%), but in terms of mean intraoperative time (85 min versus 92 min) and conversion rate (0% versus 6.4%) there was no statistically significant difference between two group.Conclusions: Same admission cholecystectomy for mild gallstone pancreatitis can significantly reduce cost and duration of hospital stay and readmission rates. With regard to intraoperative time, conversion to open, intraoperative and postoperative complication there is no statistically significant difference seen. Hence same admission cholecystectomy is safe, feasible and recommended.

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Cost-effectiveness of same-admission versus interval cholecystectomy after mild gallstone pancreatitis in the PONCHO trial

Abstract: In mild biliary pancreatitis, same-admission cholecystectomy was more effective and less costly than interval cholecystectomy.

Cited by 58 publications

References 27 publications

Readmission to hospital following laparoscopic cholecystectomy: a meta-analysis

Readmission to hospital following laparoscopic cholecystectomy: a meta-analysis

Meta-analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis

The ideal timing of cholecystectomy for mild gallstone pancreatitis

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