Cost effectiveness of laparoscopic cholecystectomy.

An investigation was undertaken to determine whether hospital charges for laparoscopic cholecystectomy are higher than those for traditional open cholecystectomy. Thirty consecutive cases of successfully completed laparoscopic procedures in a single surgeon's experience were compared to 30 open cases performed within the previous calendar year. Patients undergoing open cholecystectomy were excluded if coexisting medical problems or complications prolonged hospitalization beyond 7 days. Mean patient age was comparable (open cholecystectomy = 47.3 +/- 2.9, laparoscopic cholecystectomy = 46.5 +/- 2.7 years), as was the incidence of other significant medical problems. Average duration of hospitalization was significantly longer for open cholecystectomy (3.6 = 0.2 days) than for laparoscopic cholecystectomy (1.0 +/- days, p less than .001). Average hospital charges for open cholecystectomy were $5606 +/- 496 and for laparoscopic cholecystectomy $4726 +/- 98. Hospital charges from operating room and recovery room charges alone were $2684 +/- 131 for laparoscopic cholecystectomy and $2196 +/- 113 for open cholecystectomy. These operating room charges represent a significantly higher percentage of total hospital charges for laparoscopic cholecystectomy than open cholecystectomy patients (laparoscopic cholecystectomy = 56.3 +/- 1.9%, open cholecystectomy = 41.2 +/- 1.5%, p less than .05). Average time for return to work or normal activity was significantly shorter for laparoscopic cholecystectomy 8.6 +/- 9 days) than for open cholecystectomy (32.4 +/- 3.6 days, p less than .001). The authors conclude that laparoscopic cholecystectomy is a cost effective procedure for the treatment of symptomatic cholelithiasis, and that increased operative costs more than offset the significantly decreased length of hospitalization.