N. Cortolillo1, J. Parreco1, R. Rattan1, A. Castillo1, R. Kozol1 1University Of Miami,General Surgery Residency Program,Miami, FL, USA
Introduction:
Many prior comparisons of outcomes and costs associated with intraoperative cholangiography (IOC) have been reported. However, prior studies have been limited to initial hospitalizations or readmissions to single institutions. The purpose of this study was to compare outcomes and costs of hospitals performing routine IOC to hospitals performing non-routine IOC including readmission cost across hospitals in the US.
Methods:
The Healthcare Cost and Utilization Project’s (HCUP) Nationwide Readmission Database for 2013-2014 was queried for all patients aged 18 years or older undergoing laparoscopic cholecystectomy. Hospitals performing intraoperative cholangiography in 90% or more of cases were identified as routine and compared to non-routine hospitals. Total charges and costs were calculated according to HCUP standards. Univariable logistic regression was performed for the outcomes of interest using ten different hospital and patient variables. The variables with p<0.05 were used for multivariable logistic regression. Results were weighted for national estimates.
Results:
There were 628,280 inpatient laparoscopic cholecystectomies during the study period with 2.0% occurring in hospitals performing routine IOC. The mortality rate was 0.4%, length of stay was >7 days in 11.0%, and readmission within 30 days occurred in 6.9%. Multivariable logistic regression revealed there was no statistically significant different risk for these outcomes between routine and non-routine IOC hospitals. Table 1 shows the mean age of patients at hospitals performing routine IOC was older, but had a lower Charlson Comorbidity Index and shorter length of stay. Non-routine IOC hospitals had higher mean index total charges but lower mean index total cost. Readmission charges were similar between the groups while readmission cost was higher in routine-IOC hospitals.
Conclusion:
While outcomes are similar, non-routine IOC hospitals charge more than routine IOC hospitals. Despite this, the costs are higher in routine IOC hospitals suggesting an unnecessary cost burden placed on hospitals performing routine IOC.
