Health care providers are increasingly focused on cost
containment. One potential target for cost
containment is in-hospital management of acute cholecystitis
. Ensuring cholecystectomy within 24 hours for cholecystitis could mitigate costs associated with longer hospitalizations. We sought to determine the cost
consequences of delaying operative management.
The Nationwide Inpatient Sample (2003–2011) was queried for adult patients (≥16 years) who underwent laparoscopic cholecystectomy
for a primary diagnosis of acute cholecystitis
. Patients who underwent open procedures or endoscopic retrograde cholangiopancreatography were excluded. Generalized linear models (GLMs) were used to analyze costs for each day’s delay in surgery. Multivariable analyses adjusted for patient demographics, hospital descriptors, Charlson comorbidity index, mortality, and length of stay.
We analyzed 191,032 records. Approximately 65% of the patients underwent surgery within 24 hours of admission. The average cost
of care for surgery on the admission day was $11,087. Costs disproportionately increased by 22% on the second hospital day ($13,526), by 37% on the third day ($15,243), by 52% on the fourth day ($16,822), by 64% on the fifth day ($18,196), by 81% on the sixth day ($20,125), and by 100% on the seventh day ($22,250) when compared with the cost
of care for procedures performed within 24 hours of admission. Subset analysis of patients discharged 24 hours or earlier from the time of surgery demonstrated similar trends.
After controlling for patient- and hospital-related factors, we noted significant costs associated with each day’s delay in operative management. Cost
containment practices for acute cholecystitis
justify consideration of same-day or next-day surgery where the diagnosis is straightforward.
LEVEL OF EVIDENCE
Economic and value-based analysis, level III.