National analysis of in-hospital resource utilization in choledocholithiasis management using propensity scores

Poulose, Benjamin K.; Arbogast, Patrick G.; Holzman, Michael D.

doi:10.1007/s00464-005-0235-1

Cited by 99 publications

(82 citation statements)

References 18 publications

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“…It is important also to note that, although the laparoscopic technique appears to be equivalent to ERCP and may be more cost effective 17,33 , it has not been widely accepted by the surgical community 17 . A recent survey of general surgeons practising in the USA showed that, although 30 (44 per cent) of 68 confirmed they could perform laparoscopic CBD exploration, only 15 (22 per cent) actually did so routinely 5 .…”

Section: Discussionmentioning

confidence: 99%

“…With the development of accurate preoperative non-invasive CBD imaging based on magnetic resonance cholangiopancreatography, further complex preoperative algorithms were instituted 16 . Today, the laparoscopic management of choledocholithiasis is increasingly reported with the emergence of an argument to return to one-stage surgical management of choledocholithiasis 17 ; this has not been widely accepted by general surgeons 5 .…”

Section: Introductionmentioning

confidence: 99%

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Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ

Clayton

Connor

Alexakis

et al. 2006

British Journal of Surgery

147

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ

Clayton

Connor

Alexakis

et al. 2006

British Journal of Surgery

147

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“…Prospective studies of laparoscopic management of CBDS that included more than 200 patients report success rates ranging from 88% to 97% (mean 92%) [3,4,9], similar to ES success rates, which range from 81% to 100% (mean 91%), but the clearance of CBDS after ES is obtained in 17-35% of cases after two to five attempts [5][6][7]11], while laparoscopic treatment of CBDS is a one-stage procedure.…”

Section: Discussionmentioning

confidence: 94%

“…Several reports have demonstrated the feasibility, safety, efficiency and cost-effectiveness of laparoscopic techniques [1][2][3][4]. Prospective studies of laparoscopic management of CBD stones (CBDS) that included more than 200 patients report success rates ranging from 88% to 97% (mean 92%) [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Comparative prospective randomized trial: laparoscopic versus open common bile duct exploration

Grubnik¹,

Ткаченко²,

Vorotyntseva³

2011

Videosurgery and Other Miniinvasive Techniques

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years (range 27 to 87 years). There were two groups of patients. Group I: laparoscopic CBD exploration (138 patients). Group II: open CBD exploration (118 patients). Patient comorbidity was assessed by means of the American Society of Anesthesiologists (ASA) classification; ASA II -109 patients, ASA III -59 patients. Bile duct stones were visualized preoperatively by means of US examination in 129 patients, by means of ERCP in 26 patients, and by magnetic resonance cholangiopancreatography (MRCP) in 72 patients. Preoperative evaluation was done through medical history, biochemical tests and ultrasonography. Results: The mean duration of laparoscopic procedures was 82 min (range 40-160 min). The mean duration of open procedures was 90 min (range 60-150 min). Mean blood loss was much lower in the laparoscopic

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Optimizing Choledocholithiasis Management

Poulose

Speroff²,

Holzman³

2007

Arch Surg

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Hypothesis: Endoscopic retrograde cholangiopancreatography (ERCP) is more cost-effective for managing incidental choledocholithiasis (CDL) after laparoscopic cholecystectomy and intraoperative cholangiogram (LC/IOC) than laparoscopic common bile duct exploration (LCBDE).Design: A cost-effectiveness analysis was performed to compare ERCP with LCBDE. Sensitivity analyses were performed to determine the key contributors to costeffectiveness between the 2 treatment options.Setting: Costs were approached from the institutional perspective considering a typical patient undergoing LC/IOC at a large referral center.Patients: The base case patient evaluated was a woman 18 years of age or older with symptomatic cholelithiasis and incidental CDL discovered at the time of LC/IOC.Interventions: Endoscopic retrograde cholangiopancreatography with drainage procedure performed after LC/IOC or LCBDE during LC/IOC.Main Outcome Measures: Costs, quality-adjusted life years gained, mean cost-effectiveness ratios, and incremental cost-effectiveness ratios.Results: In the base case analysis, ERCP was the optimal treatment choice with a cost of $24 300 for 0.9 qualityadjusted life years gained compared with $28 400 and 0.88 quality-adjusted life years for LCBDE. Endoscopic retrograde cholangiopancreatography remained the optimal strategy for CDL in multiway probabilistic sensitivity analysis. If LCBDE were performed and the cost of a potential operative case lost was $3100 or less and the cost of ERCP hospitalization was $18 000 or more, then LCBDE became the preferred treatment for CDL.Conclusions: Endoscopic retrograde cholangiopancreatography was both less costly and more effective than LCBDE. Factors important to choosing the best strategy for CDL management included the cost of a potential case lost due to LCBDE performance and the cost of ERCP hospitalization.

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National analysis of in-hospital resource utilization in choledocholithiasis management using propensity scores

Abstract: Based on this PS analysis, CBDE incurs less THC, reduces LOS, and has less estimated costs for CDL compared to ERCP. Furthermore, CBDE appears to be dramatically underutilized.

Cited by 99 publications

References 18 publications

Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ

Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ

Comparative prospective randomized trial: laparoscopic versus open common bile duct exploration

Optimizing Choledocholithiasis Management

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