Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555-0541, USA.
Surgery. 2012 Sep;152(3):363-75. doi: 10.1016/j.surg.2012.06.013.
Controversy exists regarding the use of concurrent cholecystectomy during Roux-en-Y gastric bypass performed for morbid obesity.
A decision model was developed to evaluate the cost-effectiveness of current strategies: routine concurrent cholecystectomy, Roux-en-Y gastric bypass alone with or without postoperative ursodiol therapy, and selective cholecystectomy based on preoperative findings on ultrasonography. Probabilities were obtained from a comprehensive literature review. Costs and hospital days were obtained from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. One-way sensitivity analyses were performed.
The least expensive strategy was to perform RYGB alone without preoperative ultrasonography, with an average cost (over RYGB costs) of $537 per patient. RYGB with concurrent cholecystectomy had a cost of $631. Selective cholecystectomy based on preoperative ultrasonography was dominated by the other 2 strategies. Our model was most sensitive to the probability of developing gallbladder-related symptoms after RYGB alone. When the incidence of gallbladder-related symptoms was <4.6%, the dominant strategy was to perform a RYGB alone without preoperative ultrasonography. For values >6.9%, performing concurrent cholecystectomy at the time of the RYGB was superior to other strategies. When ursodiol was used, the least expensive strategy was to perform a concurrent cholecystectomy during RYGB.
The main factor determining the most cost-effective strategy is the incidence of gallbladder-related symptoms after RYGB. The use of ursodiol was associated with an increase in cost that does not justify its use after RYGB. Finally, selective cholecystectomy based on preoperative ultrasonography was dominated by the other strategies in the scenarios evaluated.
在肥胖症患者行 Roux-en-Y 胃旁路手术时，同期行胆囊切除术存在争议。
建立决策模型来评估当前策略的成本效益：常规同期胆囊切除术、单独行 Roux-en-Y 胃旁路术，以及根据术前超声检查结果选择性胆囊切除术。概率来自全面的文献综述。成本和住院天数来自 Healthcare Cost and Utilization Project Nationwide Inpatient Sample。进行了单因素敏感性分析。
最便宜的策略是在没有术前超声检查的情况下单独进行 RYGB，每位患者的平均费用（超过 RYGB 费用）为 537 美元。RYGB 同期行胆囊切除术的费用为 631 美元。根据术前超声检查结果选择性胆囊切除术被其他 2 种策略所主导。我们的模型对单独行 RYGB 后发生胆囊相关症状的概率最为敏感。当胆囊相关症状的发生率<4.6%时，主要策略是在没有术前超声检查的情况下单独进行 RYGB。对于发生率>6.9%的情况，在 RYGB 时同期行胆囊切除术优于其他策略。使用熊去氧胆酸时，最便宜的策略是在 RYGB 时同期行胆囊切除术。
决定最具成本效益策略的主要因素是 RYGB 后胆囊相关症状的发生率。使用熊去氧胆酸会增加成本，但不能证明其在 RYGB 后使用是合理的。最后，根据术前超声检查结果选择性胆囊切除术在评估的方案中被其他策略所主导。
