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A propensity score matched comparison of readmissions and cost of laparoscopic cholecystectomy vs percutaneous cholecystostomy for acute cholecystitis

Published:November 01, 2018DOI:https://doi.org/10.1016/j.amjsurg.2018.10.047

      Highlights

      • Percutaneous cholecystostomy (PC) use is increasing for acute cholecystitis (AC).
      • Cost comparison of PC vs laparoscopic cholecystectomy for (AC) remains unknown.
      • Propensity matched PC patients had increased risk for 30- and 60-day readmission.
      • Matched PC patients had lower index costs, but higher 30- and 60-day costs.

      Abstract

      Background

      Percutaneous cholecystostomy (PC) is an initial alternative to laparoscopic cholecystectomy (LC) for complicated acute cholecystitis (AC). No studies have directly compared costs of index hospitalization and readmissions between PC and LC patients.

      Methods

      The Nationwide Readmissions Database was queried for patients undergoing PC or LC for AC from 2013 through 2014. Primary outcomes including length of stay, and index and total hospital costs at 30- and 60-days were evaluated after 1:1 propensity score matching for patient and hospital characteristics.

      Results

      PC patients had increased index hospital length of stay: 6 days vs 5 days (p < 0.01). Index admission cost was cheaper for PC ($12,839 vs $13,345, p = 0.028). Total cost, including readmissions, was significantly increased in PC patients: 30-days (LC: $13,947, PC: $14,592, p = 0.029) and 60-days (LC: $14,280, PC: $16,518, p < 0.0001).

      Conclusions

      PC patients were more frequently readmitted, had longer hospital stays, and increased hospital costs compared to those undergoing LC.

      Keywords

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