The added cost of urgent cholecystectomy to health systems

BACKGROUND: The purpose of this study is to assess the cost and reimbursement differential between elective and urgent laparoscopic cholecystectomy. STUDY DESIGN: All visits for laparoscopic cholecystectomy (ICD-9 Code 51.23) to the University of Michigan Health System were reviewed for 1997 to 2001 (n = 752). Data were obtained from the University of Michigan Data Warehouse. Patients were grouped into urgent and elective cases, and further subgrouped into complicated and uncomplicated cases based on Diagnostic Related Group (DRG) coding. Total costs were determined for 13 distinct facility cost centers with average costs greater than $10 per case. Reimbursement was also assessed. RESULTS: Total costs were approximately 90% higher in urgent cases. The largest contributors to increased costs were nursing care and pharmacy costs. The emergent group experienced a pre-operative delay to surgery of 1.8 days. Reimbursement was similar for both elective and urgent patients when stratified by complicated and uncomplicated DRGs. CONCLUSIONS: The urgency of the operation significantly elevates the costs and resource consumption associated with laparoscopic cholecystectomy. These cost differences should also be recognized when setting reimbursement premiums under risk-bearing systems, such as Medicare Diagnosis Related Group reimbursement. Consideration for including urgent operation as a comorbidiry should be assessed. (C) 2003 by the American College of Surgeons.