Savader S J, Lillemoe K D, Prescott C A, Winick A B, Venbrux A C, Lund G B, Mitchell S E, Cameron J L, Osterman F A
Russell H. Morgan Department of Radiology and Radiological Science, The John Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Ann Surg. 1997 Mar;225(3):268-73. doi: 10.1097/00000658-199703000-00005.
This study was designed to evaluate the total costs associated with repair of laparoscopic cholecystectomy (LC)-related bile duct injuries.
The popularity of LC with both patients and surgeons is such that this procedure now exceeds open cholecystectomy by a ratio of approximately 4 to 10:1. However, costs associated with LC-related injuries, particularly regarding treatment patterns, have up to now not been explored fully.
The complete hospital and interventional radiology (IR) billing records for 49 patients who have completed treatment for laparoscopic cholecystectomy-related bile duct injuries were divided into 8 categories. These records were totaled for comparison of costs between patient groups that experienced different injuries and treatment patterns.
Patients with LC-related bile duct injuries were billed a mean of $51,411 for all care related to repair of their bile duct injury. Patients incurred an average of 32 days of inpatient hospitalization and 10 outpatient care days. Postoperative treatment included long-term chronic biliary intubation averaging 378 days. Two patients (4%) died as a result of their LC-related complications. Patients with bile duct injuries that were recognized immediately at the time of the initial surgery ultimately experienced a total cost for their repair and hospitalization of 43% to 83% less than for patients in whom recognition of the injury was delayed (p < 0.019 to 0.070). In addition, the total hospitalization and outpatient care days was reduced by as much as 76% with early recognition of an iatrogenic injury.
Repair of cholecystectomy-related bile duct injuries can run 4.5 to 26.0 times the cost of the uncomplicated procedure and carries a significant mortality rate. Intraoperative recognition of such an injury with immediate conversion to an open procedure for definitive repair can result in significant cost savings and relates directly to a decreased morbidity, mortality, length of hospitalization, and number of outpatient care days.
本研究旨在评估与腹腔镜胆囊切除术（LC）相关胆管损伤修复相关的总成本。
LC在患者和外科医生中都很受欢迎，以至于目前该手术与开腹胆囊切除术的比例约为4比10:1。然而，与LC相关损伤的成本，特别是关于治疗模式，迄今为止尚未得到充分探讨。
49例已完成腹腔镜胆囊切除术相关胆管损伤治疗的患者的完整医院和介入放射学（IR）计费记录分为8类。汇总这些记录，以比较经历不同损伤和治疗模式的患者组之间的成本。
与LC相关胆管损伤的患者因胆管损伤修复的所有护理平均被计费51,411美元。患者平均住院32天，门诊护理10天。术后治疗包括平均378天的长期慢性胆管插管。两名患者（4%）因LC相关并发症死亡。在初次手术时立即被识别出胆管损伤的患者，其修复和住院的总成本最终比损伤识别延迟的患者少43%至83%（p<0.019至0.070）。此外，早期识别医源性损伤可使总住院天数和门诊护理天数减少多达76%。
胆囊切除术相关胆管损伤的修复成本可能是未发生并发症手术的4.5至26.0倍，且死亡率较高。术中识别此类损伤并立即转为开放手术进行确定性修复可显著节省成本，并直接降低发病率、死亡率、住院时间和门诊护理天数。
