Impact of Early Cholecystectomy on the Cost of Treating Mild Gallstone Pancreatitis: Gallstone PANC Trial
| Autor: | Karla Bernardi, Krislynn M. Mueck, Tien C. Ko, Shuyan Wei, Kayla D. Isbell, Shah-Jahan M. Dodwad, Elenir Bc. Avritscher, Lillian S. Kao, Mike K. Liang, Gabrielle E. Hatton |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Healthcare use Time Factors Randomization Cost-Benefit Analysis medicine.medical_treatment Gallstones Severity of Illness Index Gastroenterology Mean difference Time-to-Treatment Postoperative Complications Internal medicine medicine Humans Cholecystectomy Endoscopic retrograde cholangiopancreatography medicine.diagnostic_test business.industry Health Care Costs Length of Stay Middle Aged medicine.disease Pancreatitis Baseline characteristics Relative risk Female Surgery business |
| Zdroj: | Journal of the American College of Surgeons. 233:517-525 |
| ISSN: | 1072-7515 |
| Popis: | Background The Gallstone Pancreatitis: Admission vs Normal Cholecystectomy (Gallstone PANC) Trial demonstrated that cholecystectomy within 24 hours of admission (early) compared with after clinical resolution (control) for mild gallstone pancreatitis, significantly reduced 30-day length-of-stay (LOS) without increasing major postoperative complications. We assessed whether early cholecystectomy decreased 90-day healthcare use and costs. Study Design A secondary economic evaluation of the Gallstone PANC Trial was performed from the healthcare system perspective. Costs for index admissions and all gallstone pancreatitis-related care 90 days post-discharge were obtained from the hospital accounting system and inflated to 2020 USD. Negative binomial regression models and generalized linear models with log-link and gamma distribution, adjusting for randomization strata, were used. Bayesian analysis with neutral prior was used to estimate the probability of cost reduction with early cholecystectomy. Results Of 98 randomized patients, 97 were included in the analyses. Baseline characteristics were similar in early (n = 49) and control (n = 48) groups. Early cholecystectomy resulted in a mean absolute difference in LOS of -0.96 days (95% CI, -1.91 to 0.00, p = 0.05). Ninety-day mean total costs were $14,974 (early) vs $16,190 (control) (cost ratio [CR], 0.92; 95% CI, 0.73-1.15, p = 0.47), with a mean absolute difference of $1,216 less (95% CI, -$4,782 to $2,349, p = 0.50) per patient in the early group. On Bayesian analysis, there was an 81% posterior probability that early cholecystectomy reduced 90-day total costs. Conclusion In this single-center trial, early cholecystectomy for mild gallstone pancreatitis reduced 90-day LOS and had an 81% probability of reducing 90-day healthcare system costs. |
| Databáze: | OpenAIRE |
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