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Impact of timing of bile duct interventions on resource use and clinical outcome of cholecystectomy patients in Japan
Author(s) -
Kuwabara Kazuaki,
Matsuda Shinya,
Fushimi Kiyohide,
Ishikawa Koichi B.,
Horiguchi Hiromasa,
Hayashida Kenshi,
Fujimori Kenji
Publication year - 2010
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/j.1365-2753.2009.01205.x
Subject(s) - cholecystectomy , medicine , psychological intervention , bile duct , general surgery , resource (disambiguation) , outcome (game theory) , intensive care medicine , nursing , computer science , computer network , mathematics , mathematical economics
Abstract Aims Laparoscopic cholecystectomy (LC) is increasingly used for acute cholecystitis, in conjunction with staged bile duct interventions (BDIs). However, few studies have evaluated the impact of BDI timing on costs and clinical outcomes during hospitalization. This study assessed the effects of several types of BDI and their timing on resource utilization and complications. Methods A total of 13 738 cholecystectomy patients were treated for benign gallbladder diseases in 66 academic and 376 community hospitals in Japan in 2006. Variables analysed included: BDIs including endoscopic retrograde cholangiopancreatography (ERCP), percutaneous gallbladder or common bile duct drainage (external drainage), endoscopic sphincterotomy, clearance of choledocholithiasis (internal drainage); and length of stay (LOS), total charges (TCs), procedure‐related complications, and hospital function. Multivariate analysis was used to determine the impact of LC or BDIs on LOS, TCs and complications. Results A total of 11 690 (85.1%) patients underwent LC. Inflammation was diagnosed in 70.7% of open cholecystectomy (OC) and 42.1% of LC patients. Complications were 7.7% in OC and 5.4% in LC patients. LC was associated with reduced LOS and TCs. BDIs were performed in more OC than LC patients. Preoperative was more costly than postoperative ERCP. Postoperative external drainage was significantly associated with LOS, TCs and complications. Advantages of pre‐ or postoperative internal drainage were not proven. Conclusions External drainage should be completed preoperatively. Postoperative ERCP may be preferable for bile duct scrutiny alone. Further evaluation of the timing of cholecystectomy will determine precisely the superiority of pre‐ or postoperative BDIs in terms of quality of care for complicated patients.