BACKGROUND: This study characterized the prevalence and treatment costs of laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) procedures performed for a population-based patient cohort. METHODS: This study analyzed 32,535 OC and 80,335 LC procedures performed in Taiwan from 1996 to 2004. The odds ratio (OR) and effect size were calculated to assess the relative change rate. Bootstrap estimation was used to derive 95% confidence intervals (CIs) for differences in effect sizes of LC and OC. Multiple regression models were used to predict total treatment cost. RESULTS: The prevalences of OC and LC were respectively 18.19 and 25.44 per 100,000 persons in 1996. In 2004, OC gradually decreased to 13.21, but LC dramatically increased to 48.35, which represented change rates of -27.38% and 90.06%, respectively. The patient characteristics associated with an increased likelihood of undergoing LC were age, female gender, and lack of current comorbidities. The total treatment cost for the OC patients increased during the study period, whereas that for the LC patients declined. The LC patients were more responsive than the OC patients with respect to average length of hospital stay (ALOS) (-0.23; 95% CI, -0.33 to -0.13) and total treatment cost (-0.43; 95% CI, -0.63 to -0.23). Considerably increased total treatment cost was associated with advanced age, female gender, one or more co-morbidities, current treatment at a medical center, and long ALOS. CONCLUSIONS: Decreases in ALOS and total treatment cost were greater for the LC patients than for the OC patients. Government officials and health care providers should understand that total treatment cost depends on both patient and hospital attributes. These results can be generalized to patient populations elsewhere in Taiwan as well as to other countries with similar patient profiles.
BACKGROUND: This study characterized the prevalence and treatment costs of laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) procedures performed for a population-based patient cohort. METHODS: This study analyzed 32,535 OC and 80,335 LC procedures performed in Taiwan from 1996 to 2004. The odds ratio (OR) and effect size were calculated to assess the relative change rate. Bootstrap estimation was used to derive 95% confidence intervals (CIs) for differences in effect sizes of LC and OC. Multiple regression models were used to predict total treatment cost. RESULTS: The prevalences of OC and LC were respectively 18.19 and 25.44 per 100,000 persons in 1996. In 2004, OC gradually decreased to 13.21, but LC dramatically increased to 48.35, which represented change rates of -27.38% and 90.06%, respectively. The patient characteristics associated with an increased likelihood of undergoing LC were age, female gender, and lack of current comorbidities. The total treatment cost for the OC patients increased during the study period, whereas that for the LC patients declined. The LC patients were more responsive than the OC patients with respect to average length of hospital stay (ALOS) (-0.23; 95% CI, -0.33 to -0.13) and total treatment cost (-0.43; 95% CI, -0.63 to -0.23). Considerably increased total treatment cost was associated with advanced age, female gender, one or more co-morbidities, current treatment at a medical center, and long ALOS. CONCLUSIONS: Decreases in ALOS and total treatment cost were greater for the LC patients than for the OC patients. Government officials and health care providers should understand that total treatment cost depends on both patient and hospital attributes. These results can be generalized to patient populations elsewhere in Taiwan as well as to other countries with similar patient profiles.
Authors: A M Carbonell; A E Lincourt; K W Kercher; B D Matthews; W S Cobb; R F Sing; B T Heniford Journal: Surg Endosc Date: 2005-05-03 Impact factor: 4.584