LAPAROSCOPIC CHOLECYSTECTOMY - ITS IMPACT ON NATIONAL-HEALTH ECONOMICS

Objective: To assess whether sound economic reasons exist for the wider introduction of laparoscopic cholecystectomy in Australia. Design: A retrospective survey of patients who underwent laparoscopic cholecystectomy. We compared time of hospital stay and time off work after laparoscopic cholecystectomy with data for open cholecystectomy. Patients and setting: Seventeen participating surgeons in four Australian States allowed access to patients treated between May 1990 and November 1991 (1254 patients in all). Main outcome measures: Patient acceptability of the procedure, average length of postoperative in-hospital stay, and the savings associated with earlier return to work compared with open-cholecystectomy. Results: Almost 90% of patients (1127) replied and 1088 responses were considered appropriate for analysis. Serious complications were rare; 96% of patients thought the technique was successful. The mean length of in-hospital stay was 2.6 days (range, 1-20), compared with a mean of 8.7 days for open cholecystectomy. Among working patients the mean time to return to work was 11.6 days (range, 10.7-13.1), an estimated 27 days sooner than after open cholecystectomy. Extrapolating from these results, replacing 95% of open cholecystectomies with laparoscopic procedures would save 133285 hospital bed-days and 500000 work-days each year. Conclusion: Laparoscopic cholecystectomy is safe and effective. Its wider use in Australia would result in saving to both th individual and the national economy.