A medical insurer's assessment of health services outcomes and patient satisfaction for laparoscopic and open cholecystectomies

In recent years, laparoscopic cholecystectomy (LC) has almost completely replaced open cholecystectomy (OC) as the preferred surgical treatment of symptomatic gallbladder disease. However, the rapid assimilation of new technologies for the management of this disease has raised concerns about overuse, costs, safety, and benefits. The purpose of the present study was to examine LC and OC in terms of health services outcomes (e.g., cost and length of stay) and patient-centered outcomes (e.g., patient satisfaction and time to return to work) from the perspective of a third party payer. A retrospective case series design was used to examine all cases for which a claim for cholecystectomy was paid by one insurer during the period January 1, 1993 to June 30, 1993. Data for the study were obtained from four sources: a review of hospital medical records, a review of hospital bills, a questionnaire filled out by the patient, and a questionnaire filled out by the attending surgeon. A total of 141 cases with complete hospital records (125 LC, 16 OC) were identified. The majority of the cases were female (79%) and obese (50%). The median age of all cases was 44 years. All cases had valid indicators for surgery according to patient symptoms, diagnostic testing, and post-operative pathology. The LC cases were significantly lower in terms of median cost of care (p = 0.002), median length of stay (p < 0.001), median procedure time (p = 0.002), median anesthesia time (p = 0.001), complication rate (p = 0.006), and time to return to work (p < 0.001). The LC cases were significantly higher in terms of the percent that recovered faster than or as quickly as anticipated (p < 0.001). LC is demonstrated in this study to be a safe surgical procedure with no mortality and an acceptable complication rate. All cases had documented signs, symptoms, and/or anatomic pathology, suggesting that there is no overuse of these surgical procedures. Claim-based insurer costs are less for the LC than for OC, due in part to less time for both the operating room and anaesthesia. LC is associated with fewer complications, quicker post-operative improvement, and quicker return to routine activities than OC.