S. Z. Wennmacker1, M. G. Dijkgraaf4, G. P. Westert3, J. P. Drenth2, C. J. Van Laarhoven1, P. R. De Reuver1 1Radboud University Medical Center,Surgery,Nijmegen, , Netherlands 2Radboud Univeristy Medical Center,Gastroenterology And Hepatology,Nijmegen, , Netherlands 3Radboud University Medical Center,Scientific Institute For Quality Of Healthcare (IQ Healthcare),Nijmegen, , Netherlands 4Academic Medical Center,Clinical Research Unit,Amsterdam, , Netherlands
Introduction: Annually, 800.000 cholecystectomies are performed in the United States and 22.000 in the Netherlands. Estimated costs of a cholecystectomy in the Netherlands are around 4000 euro’s. Gallbladder removal for symptomatic gallstones appears to be ineffective in terms of pain relief, in up to 40% of patients. Although several studies have reported on persistent abdominal pain after cholecystectomy, there is no literature on the actual burden of persistent pain to the health care system. The aim of this study is to determine health care consumption and the related costs in patients with persistent abdominal pain after cholecystectomy.
Methods: All 146 patients of a previous prospective multicenter cohort study who reported persistent abdominal pain 24 weeks after cholecystectomy between June 2012 and June 2014 were included in this study. Health care consumption was assessed in February 2016 using Patients experience of surgery questionnaire (PESQ), Medical Consumption Questionnaire (iMCQ) and patients’ medical records. Sick leave and productivity loss of (un)paid work were assessed by the Productivity Cost Questionnaire (iPCQ). Costs were calculated according the Dutch “Guideline for performing economic evaluations in health care” and reported in euro's.
Results: The response rate was 85% (124/146 patients), after a mean follow-up of 31.0 months after surgery (SD 6.5). A total of 55.6% (n=69) of patients had additional care for persistent abdominal pain after cholecystectomy; 30.6% received primary care, 37.1% received secondary care, 16% were admitted in the emergency department, and 8.9% of the patients were admitted to hospital. Diagnostic procedures were performed in 33.9% (n=42) of the patients, which revealed gallstone or surgery related causes in nine patients. In 20 patients another diagnosis was found. Additional treatment included use of medication in 17.7% (n= 22) of the patients (10% uses analgetics, 9.6% uses proton pomp inhibitors ). Additional interventions were performed in 7 patients (5.6%). Estimated mean medical costs for persistent abdominal pain since cholecystectomy were €1,239 (SD €3,573) per patient. Subsequent mean costs of sick leave and productivity loss of (un)paid work were €727 (SD €2,163) per patient.
Conclusion: Due to persistent abdominal pain after cholecystectomy, 55% of the patients needed additional health care, and one third of the patients underwent additional diagnostic procedures. Postoperative medical costs and costs of sick leave and productivity loss in patients with persistent abdominal pain are up to 50% of the initial costs of the cholecystectomy.