Regional cost analysis for laparoscopic cholecystectomy

Pontarelli, Elizabeth M.; Grinberg, Gary G.; Isaacs, Richard S.; Morris, James; Ajayi, Olakunle; Yenumula, Pandu

doi:10.1007/s00464-018-6526-0

Cited by 11 publications

(3 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Varying care practices can increase risk for inequitable application of nonoperative management and can result in increased overall complications. Particularly challenging cases notwithstanding, cholecystectomy is not usually resource-intensive or associated with significant morbidity [ 23 , 24 ]. Prior studies have demonstrated that nonoperative management in poor surgical candidates is associated with a high rate of repeat admissions for recurrent cholecystitis [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Interhospital variation in the nonoperative management of acute cholecystitis

Ali,

Chervu,

Sakowitz

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

Background Cholecystectomy remains the standard management for acute cholecystitis. Given that rates of nonoperative management have increased, we hypothesize the existence of significant hospital-level variability in operative rates. Thus, we characterized patients who were managed nonoperatively at normal and lower operative hospitals (>90th percentile). Methods All adult admissions for acute cholecystitis were queried using the 2016–2019 Nationwide Readmissions Database. Centers were ranked by nonoperative rate using multi-level, mixed effects modeling. Hospitals in the top decile of nonoperative rate (>9.4%) were classified as Low Operative Hospitals (LOH; others:nLOH). Separate regression models were created to determine factors associated with nonoperative management at LOH and nLOH. Results Of an estimated 418,545 patients, 9.9% were managed at 880 LOH. Multilevel modeling demonstrated that 20.6% of the variability was due to hospital factors alone. After adjustment, older age (Adjusted Odds Ratio [AOR] 1.02/year, 95% Confidence Interval [CI] 1.01–1.02) and public insurance (Medicare AOR 1.31, CI 1.21–1.43 and Medicaid AOR 1.43, CI 1.31–1.57; reference: Private Insurance) were associated with nonoperative management at LOH. These were similar at nLOH. At LOH, SNH status (AOR 1.17, CI 1.07–1.28) and small institution size (AOR 1.20, CI 1.09–1.34) were associated with increased odds of nonoperative management. Conclusion We noted a significant variability in the interhospital variation of the nonoperative management of acute cholecystitis. Nevertheless, comparable clinical and socioeconomic factors contribute to nonoperative management at both LOH and non-LOH. Directed strategies to address persistent non-clinical disparities are necessary to minimize deviation from standard protocol and ensure equitable care.

show abstract

Section: Discussionmentioning

confidence: 99%

Interhospital variation in the nonoperative management of acute cholecystitis

Ali,

Chervu,

Sakowitz

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

show abstract

“… 1 Around 600,000 laparoscopic cholecystectomies are performed annually, making it the most common surgery in the United States. 2 These cholecystectomies are technically challenging surgical procedures resulting in high rates of iatrogenic complications such as bile duct injury, bleeding, infection, or death. 3 Due to the high morbidity of cholecystectomy complications, alternative medical therapies, such as neutrophil extracellular trap (NET) inhibitors, are being tested in animal studies.…”

Section: Introductionmentioning

confidence: 99%

Medical Therapies to Conquer Surgical Diseases: Gallstone Disease May Be the Next Frontier

Horneck,

Ahmed,

Umemoto

et al. 2024

IJGM

View full text Add to dashboard Cite

Over the past half century, diseases that were predominantly treated surgically have transitioned to less invasive medical therapies. Such diseases that are now effectively treated with medicine are (1) peptic ulcer disease (PUD), (2) coronary artery disease (CAD), and (3) gastrointestinal stromal tumors (GISTs). Likewise, gallstone disease may soon follow this trend. Currently, the gold standard treatment of symptomatic gallstones is laparoscopic cholecystectomies. Though one of the most common surgeries in the United States, certain cases of acute and gangrenous cholecystitis can be some of the most difficult surgeries to perform. Advancements in neutrophil extracellular trap (NET) inhibitor medical therapies will alter gallstone disease management and the mainstream role of surgical interventions. This focus on less invasive therapies will greatly impact the quality of patient care, financial obligations, and even resident training opportunities.

show abstract

“…The clarity database is built into the itemized cost tool using automated Tableau software analysis as previously described. 9 …”

mentioning

confidence: 99%

Cost Comparison: Evaluating Transfemoral and Transradial Access for Diagnostic Cerebral Angiography

Dodd

Small

Goutnik

et al. 2023

SVIN

View full text Add to dashboard Cite

BACKGROUND Modern medicine necessitates the delivery of increasingly complex health care while minimizing cost. Transradial access (TRA) for neuroendovascular procedures is becoming more common as accumulating data demonstrate fewer complications, improved patient satisfaction, and high rates of treatment success compared with the transfemoral access (TFA) approach; however, disparities in cost between these approaches remain unclear. We compared supply and equipment costs between TRA and TFA for diagnostic cerebral angiography and evaluate the specific items that account for these differences. METHODS We reviewed all adult patients who underwent diagnostic cerebral angiography from July 1, 2019 to December 31, 2019. Data related to patient demographics, vascular access site, catheters used, cost of catheters, arterial access sheath use, cost of sheaths, closure devices used, and cost of closure devices were collected. RESULTS The transradial approach resulted in higher price of radial access sheath; however, the overall cost of closure devices was much lower in TRA group than in the TFA cohort. There was no significant difference in the cost of catheters. Overall, the total supply costs for TRA cerebral angiography were significantly lower than those of TFA cerebral angiography. The relative materials cost difference of using TRA was 20.9%. CONCLUSION This study is the first itemized materials cost analysis of TRA versus TFA cerebral angiography. TRA necessitates the use of a more expensive access sheath device; however, this cost is offset by the increased cost of devices used for femoral arteriotomy closure. Overall, the supply and equipment costs were significantly lower for TRA than TFA.

show abstract

Regional cost analysis for laparoscopic cholecystectomy

Cited by 11 publications

References 17 publications

Interhospital variation in the nonoperative management of acute cholecystitis

Interhospital variation in the nonoperative management of acute cholecystitis

Medical Therapies to Conquer Surgical Diseases: Gallstone Disease May Be the Next Frontier

Cost Comparison: Evaluating Transfemoral and Transradial Access for Diagnostic Cerebral Angiography

Contact Info

Product

Resources

About