Chu Woon Ng and Andreas Lambrianides
Background: Laparoscopic cholecystectomy is the preferred and widely used treatment modality for acute cholecystitis. Despite several positive outcomes, such as shorter hospital stay, less number of complications, it is sometimes not feasible to perform because of the need of trained specialists and high expenditure as it involves sophisticated expensive instruments. The purpose of this study was to determine differences in procedure duration, length of stay, outcomes, and cost based on types of surgery performed in the year 2004-2005 and 2014-2015.
Methods: The study design was a 10-year interval retrospective study conducted in a district hospital in Queensland, Australia. Data were extracted from the hospital record for the years 2004-2005 and 2014-2015. Incomplete and inaccurate data were excluded from the study and a total of 247 records were included in the final analysis. Fischer’s exact test, Chi-Square test and Mann-Whitney U test with 0.05 level of significance were used. Odds ratio with 95% confidence interval were also calculated.
Results: Patients treated with laparoscopic surgery had significantly shorter hospital stay than those treated with mini-open surgery (p<0.001), and it was consistent for both time period. Antibiotic use and postoperative complications were significantly higher in mini-open cholecystectomy cases (p<0.05). Operative time was significantly less in the laparoscopic group compared with mini-open surgery in 2004-2005, but no significant difference was noted in 2014-2015. Lack of cost components restricts direct comparison of cost. However, increased complication, antibiotic use, and longer stay suggest high indirect cost in patients treated with mini-open cholecystectomy.
Conclusion: Laparoscopic cholecystectomy has become the preferred management of acute cholecystitis. This research provides evidence on improved intraoperative and postoperative outcome in laparoscopic cholecystectomy compared to mini-open cholecystectomy. Shorter hospital stay, less postoperative complications, and less antibiotic use make this technique more cost-effective. However, a longitudinal study using cost-effectiveness analysis in the future will provide a robust conclusion.