Economics of emergency laparoscopic cholecystectomy at an Australian tertiary centre in the post COVID-19 era

Raymond Hayler; Sam Hanna; Andrea Boerkamp; Yijun Gao; Sam T Alhayo; Michael L Talbot

doi:10.1016/j.amjsurg.2024.116158

Economics of emergency laparoscopic cholecystectomy at an Australian tertiary centre in the post COVID-19 era

Am J Surg. 2024 Dec 20:241:116158. doi: 10.1016/j.amjsurg.2024.116158. Online ahead of print.

Authors

Raymond Hayler¹, Sam Hanna², Andrea Boerkamp², Yijun Gao³, Sam T Alhayo³, Michael L Talbot³

Affiliations

¹ Upper GastroIntestinal Unit, Department of Surgery, St George Public Hospital, NSW Health, Australia; UNSW Department of Surgery, St George & Sutherland Clinical School, The University of New South Wales, Sydney, New South Wales, Australia. Electronic address: [email protected].
² Upper GastroIntestinal Unit, Department of Surgery, St George Public Hospital, NSW Health, Australia.
³ Upper GastroIntestinal Unit, Department of Surgery, St George Public Hospital, NSW Health, Australia; UNSW Department of Surgery, St George & Sutherland Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.

PMID: 39740648
DOI: 10.1016/j.amjsurg.2024.116158

Abstract

Background: Laparoscopic cholecystectomy (LC) is a common operation performed worldwide. Indications include acute cholecystitis (AC), with a trend of increasing complexity post-COVID-19. We aim to evaluate the health expenditure on LC at an Australian tertiary centre.

Methods: A retrospective chart review was performed for all LC between July 1, 2022-June 30, 2023 collecting demographics, costs and wait times and comparisons performed between elective and emergency LC.

Results: 125 patients underwent emergency and 78 elective LC. There was no difference between age, sex or ASA. 67 patients (53.6 %) had emergency LC within their booking priority category. Average cost for emergency LC was $12,689.90 with a median stay of four days, compared to $7181.10 and one day for elective (p < 0.01). Operative related costs were the majority with emergency LC higher ($4866.5, 38.4 % v $3957.6, 55.1 % p = 0.02). The largest cost disparity was nursing costs ($2193.7, 17.3 % v 648.3, 9 % p < 0.01).

Conclusion: Costs are likely driven by access to emergency theatre time and increased length of stay. A semi-emergency theatre model could save costs.