Costos de las diversas modalidades posoperatorias de la colecistectomía laparoscópica. Cooperativa Médica de Florida (COMEF), 2016-2021 / Cost effectivenes of the different postoperative management modalities in laparoscopic cholecystectomy Florida Medical Cooperative (COMEF) 2016-2021 / Custos das várias modalidades pós-operatórias do colecistectomia laparoscópica. Cooperativa Médica da Flórida (COMEF). 2016-2021

Introducción: la colecistectomía laparoscópica constituye el patrón oro en el tratamiento de la litiasis biliar. Bajo una estricta selección de pacientes, la modalidad ambulatoria ha demostrado ser factible y segura. En COMEF se realiza desde el año 2016. El posoperatorio transcurrió por diferentes etapas, internación en cuidados moderados, internación en sala de cirugía del día más internación domiciliaria, internación únicamente en sala de cirugía del día y finalmente alta domiciliaria desde block quirúrgico. El objetivo del trabajo es calcular los costos de cada una de las modalidades posoperatorias de la colecistectomía laparoscópica en el período 2016-2021. Materiales y método: se realizó un estudio de costos de cada una de las modalidades posoperatorias mediante la determinación del costo del día cama ocupada en cuidados moderados e internación domiciliaria, así como la retribución de un auxiliar de enfermería encargado de la sala de cirugía del día. Los datos fueron obtenidos de la Estructura de Costos de Atención a la Salud y la producción de cada servicio. Resultados: el costo del día cama ocupada en cuidados moderados es de $15.056, el de internación en sala de cirugía del día y luego internación domiciliaria $4.953,69, únicamente en sala de cirugía del día $807,69 y finalmente el alta domiciliaria desde block quirúrgico $33. Conclusiones: los costos del posoperatorio de la colecistectomía laparoscópica en modalidad ambulatoria son menores que los que requieren internación en cuidados moderados, y dichos costos se reducen progresivamente cuando se pasa de la internación domiciliaria al alta sin internación domiciliaria y sin recuperación en sala de cirugía del día.

Introduction: laparoscopic cholecystectomy constitutes the gold standard to treat gallstones. Ambulatory treatment has proved to be feasible and safe for carefully selected patients. At COMEF, laparoscopic cholecystectomies have been performed since 2016, and postoperative management has covered different stages: intermediate care during hospitalization, admission in day surgery units plus home care or home admissions, hospitalization in day surgery units and discharge directly after surgery, directly from the ER. The study aims to calculate the cost of each one of the different postoperative management modalities for laparoscopic cholecystectomies between 2016 and 2021. Method: a cost study was conducted for each one of the postoperative management modalities by calculating the cost of the hospital bed day in intermediate care and house care, as well as the salary of the nurses' staff at the day surgery unit. Data was obtained from the Healthcare Services Cost Structure and the production of each one of the services mentioned. Results: the daily bed day cost in intermediate care is $ 15,056, the daily cost of day surgery unit plus home care afterwards is $ 4,953.69, the cost of surgery admission in the day surgery unit is $ 807.69 and discharge directly from the OR is $ 33. Conclusions: the postoperative cost of ambulatory laparoscopic cholecystectomy is lower than that requiring interaction in intermediate care and these costs are progressively reduced when moving from home care with and without interaction upon discharge towards no recovery in the day surgery unit.

Introdução: a colecistectomia laparoscópica é o padrão ouro no tratamento da litíase biliar. Com uma rigorosa seleção de pacientes, a modalidade ambulatorial tem se mostrado viável e segura. Na COMEF é realizada desde 2016, com o pós-operatório passando por diferentes etapas: internação em cuidados moderados, internação na sala de cirurgia do dia mais internação domiciliar, internação apenas na sala de cirurgia no dia e finalmente alta domiciliar do bloco cirúrgico. Objetivo: calcular os custos de cada uma das modalidades pós-operatórias de colecistectomia laparoscópica no período 2016-2021. Materiais e método: foi realizado um estudo dos custos de cada uma das modalidades pós-operatórias determinando o custo do dia de leito ocupado em cuidados moderados e internação atendimento domiciliar, bem como a remuneração de um auxiliar de enfermagem responsável pela cirurgia do dia. Os dados foram obtidos da Estrutura de Custos de Assistência à Saúde e da produção de cada serviço. Resultados: o custo do leito de dia ocupado em cuidados moderados, em é de $ 15.056, a hospitalização na sala de cirurgia de dia e depois internação domiciliar $ 4.953,69, apenas na sala da cirurgia de dia $ 807,69 e finalmente alta domiciliar do bloco cirúrgico $ 33 (valores em pesos uruguaios). Conclusões: os custos pós-operatórios da colecistectomia laparoscópica na modalidade ambulatorial são menores do que aqueles que requerem interação em cuidados moderados e são progressivamente reduzidos quando passa da internação em casa à alta sem interação em casa e sem recuperação na sala de cirurgia no dia.

Ambulatory laparoscopic cholecystectomy is safe and cost-effective

ABSTRACT Background - Laparoscopic cholecystectomy is the treatment of choice for gallstone disease, and has been perfomed as an outpatient surgery in many Institutions over the last few years. Objective - This is a retrospective study of a single center in Brazil, that aims to analyze the outcomes of 200 cases of ambulatory laparoscopic cholecystectomy performed by the same Hepato-Pancreato-Biliary team, evaluating the safety and cost-effectiveness of the method. Methods - Two hundred consecutive patients who underwent elective laparoscopic cholecystectomy were retrospectively analyzed; some of them underwent additional procedures, as liver biopsies and abdominal hernias repair. Results - From a total of 200 cases, the outpatient surgery protocol could not be carried out in 22 (11%). Twenty one (95.5%) patients remained hospitalized for 1 day and 1 (4.5%) patient remained hospitalized for 2 days. From the 178 patients who underwent ambulatory laparoscopic cholecystectomy, 3 (1.7 %) patients returned to the emergency room before the review appointment. Hospital cost was on average 35% lower for the ambulatory group. Conclusion - With appropriate selection criteria, ambulatory laparoscopic cholecystectomy is feasible, safe and effective; readmission rate is low, as well as complications related to the method. Cost savings and patient satisfaction support its adoption. Other studies are necessary to recommend this procedure as standard practice in Brazil.

RESUMO Contexto - A colecistectomia laparoscópica é o tratamento de escolha da colelitíase, e tem sido realizada de maneira ambulatorial em diversas instituições nos últimos anos. Objetivo - Esse é um estudo retrospectivo de um grande centro no Brasil, que tem por objetivo analisar os resultados de 200 casos de colecistectomia laparoscópica ambulatorial realizadas pela mesma equipe de cirurgia Hepato-Pancreato-Biliar, avaliando a segurança e custo-efetividade do método. Métodos - Duzentos pacientes consecutivos submetidos à colecistectomia laparoscópica eletiva foram analisados retrospectivamente; alguns realizaram em conjunto outros procedimentos adicionais, como biópsias hepáticas e reparo de hérnias de parede abdominal. Resultados - De um total de 200 casos, o protocolo de cirurgia ambulatorial não pôde ser concluído em 22 (11%). Vinte e um (95.5%) pacientes permaneceram hospitalizados por 1 dia e um (4,5%) paciente por 2 dias apenas. Dos 178 pacientes que foram submetidos à colecistectomia laparoscópica ambulatorial, 3 (1,7%) retornaram à emergência antes da data prevista. O custo hospitalar foi em média 35% menor no grupo ambulatorial. Conclusão - Com critérios de seleção apropriados, a colecistectomia laparoscópica ambulatorial é factível, segura e custo-efetiva; a taxa de readmissão é baixa, assim como as complicações relacionadas ao método. A redução de custos e a satisfação dos pacientes respaldam sua realização. Outros estudos são necessários para recomendar esse procedimento como padrão no Brasil.

Total cost of hospitalization of patients undergoing elective laparoscopic cholecystectomy related to nutritional status / Custo total de internação de pacientes submetidos à colecistectomia videolaparoscópica eletiva relacionado ao estado nutricional

ABSTRACT Background: In the Western world, the population developed an overweight profile. The morbidly obese generate higher cost to the health system. However, there is a gap in this approach with regard to individuals above the eutrofic pattern, who are not considered as morbidly obese. Aim: To correlate nutritional status according to BMI with the costs of laparoscopic cholecystectomy in a public hospital. Method: Data were collected from medical records about: nutritional risk assessment, nutricional state and hospital cost in patients undergoing elective laparoscopic cholecystectomy. Results: Were enrolled 814 procedures. Average age was 39.15 (±12.16) years; 47 subjects (78.3%) were women. The cost was on average R$ 6,167.32 (±1830.85) to 4.06 (±2.76) days of hospitalization; 41 (68.4%) presented some degree of overweight; mean BMI was 28.07 (±5.41) kg/m²; six (10%) individuals presented nutritional risk ≥3. There was a weak correlation (r=0.2) and not significant (p <0.08) between the cost of hospitalization of the sample and length of stay; however, in individuals with normal BMI, the correlation was strong (r=0,57) and significant (p<0.01). Conclusion: Overweight showed no correlation between cost and length of stay. However, overweight individuals had higher cost of hospitalization than those who had no complications, but with no correlation with nutritional status. Compared to those with normal BMI, there was a strong and statistically significant correlation with the cost of hospital stay, stressing that there is normal distribution involving adequate nutritional status and success of the surgical procedure with the consequent impact on the cost of hospitalization.

RESUMO Racional: No mundo ocidental, a população desenvolveu um perfil de excesso de peso corporal. Os obesos mórbidos geram custo mais alto para o sistema de saúde. Entretanto, observa-se um hiato no tocante aos indivíduos acima do eutrofismo, mas não considerados obesos mórbidos. Objetivo: Correlacionar estado nutricional, segundo o IMC, com custo de internação de colecistectomias videolaparoscópicas. Método: Coleta de dados dos prontuários sobre: avaliação de risco nutricional, estado nutricional e custo de internação de pacientes submetidos à colecistectomia videolaparoscópica eletiva no período de janeiro de 2012 a dezembro de 2014. Resultados: Foram analisados 814 procedimentos. A idade média foi de 39,15 (±12,16) anos; 47 (78,3%) eram mulheres. O custo de internação foi, em média, de R$ 6.167,32 (±1.830,85) para 4,06 (±2,76) dias de internação. Quarenta e um (68,4%) pacientes apresentavam algum grau de sobrepeso; o IMC médio foi 28,07 (±5,41) kg/m²; seis (10%) indivíduos apresentavam risco nutricional ≥3. Houve correlação fraca (r=0,2) e não significativa (p<0,08) entre o custo de hospitalização e o tempo de permanência. No entanto, em indivíduos com IMC normal, a correlação foi forte (r=0,57) e significante (p<0,01). Conclusão: Sobrepeso não demonstrou correlação entre custo e tempo de internação. Entretanto, os indivíduos com sobrepeso apresentaram custo maior de internação em relação aos que não tiveram intercorrência, mas sem correlação com o estado nutricional. Em relação aos com IMC normal, houve correlação forte e estatisticamente significante com o custo para tempo de internação, reforçando que há provável distribuição normal envolvendo estado nutricional adequado e sucesso do procedimento cirúrgico com consequente impacto no custo de internação.

Single-Fulcrum Laparoscopic Cholecystectomy in Uncomplicated Gallbladder Diseases: A Retrospective Comparative Analysis with Conventional Laparoscopic Cholecystectomy

PURPOSE: Single-fulcrum laparoscopic cholecystectomy (SFLC) is a variant type of single incision and multi-port technique that does not use specialized one-port devices or articulating instruments. We retrospectively compared perioperative outcomes of SFLC with those of conventional laparoscopic cholecystectomy (CLC). MATERIALS AND METHODS: Between March 2009 and December 2010, SFLC was performed in 130 patients. Among them, 105 patients with uncomplicated gallbladder disease (no inflammation or no clinical symptoms) and another 105 patients who underwent CLC were selected for this study. RESULTS: There was no open conversion. In comparison with CLC, SFLC was performed more often in young (46.4+/-12.2 years vs. 52.5+/-13.6 years, p=0.001) female patients (80/25 vs. 62/43, p=0.008). The total operation time was longer in SFLC (56.7+/-14.1 min vs. 47.5+/-17.1 min, p<0.001), but pain scores immediately after operation and at discharge time were lower for SFLC than for CLC (3.1+/-1.3 vs. 4.0+/-1.9, p<0.001, 2.0+/-0.9 vs. 2.4+/-0.8, p=0.002). Total cost was lower for SFLC than for CLC (US $ 1801+/-289.9 vs. US $ 2003+/-617.4, p=0.004). There were no differences in hospital stay or complication rates. CONCLUSION: SFLC showed greater technical feasibility and cost benefits in treating uncomplicated benign gallbladder disease than CLC.

Costo-efectividad de la colecistectomía laparoscópica y de la abierta en una muestra de población colombiana / Cost-effectiveness of laparoscopic versus open cholecystectomy

Introducción. La colecistectomía ha sido objeto de varios estudios clínicos y de costos a nivelmundial. Objetivo. Evaluar el costo-efectividad de la colecistectomía abierta y de la laparoscópica desde laperspectiva del tercer pagador. Materiales y métodos. Se llevó a cabo un estudio de costo-efectividad en dos hospitales de Bogotá. Se obtuvieron los datos de efectividad de las cirugías a partir de un estudio de cohortes, y se obtuvo enforma retrospectiva el tipo de colecistectomía y en forma prospectiva, el resultado. Se incluyeron 376 pacientes intervenidos por colecistitis o litiasis de mayo de 2005 a junio de 2006; 156 pacientes fueron intervenidos por colecistectomía abierta y 220 por laparoscopia. Los resultados que se analizaron fueron los siguientes: frecuencia de complicaciones, estancia hospitalaria, reincorporación a las labores cotidianas y duración de la cirugía. Los costos se recolectaron según el tipo de estudio económico y sólo se incluyeron los costos directos. Posteriormente, se planteó un estudio de costo-efectividad a un año desde la perspectiva del tercer pagador; se propuso un modelo de árbol de decisiones y se calcularon las razones de incremento de costo-efectividad para cada uno de los desenlaces propuestos. Resultados. Los resultados de la colecistectomía abierta frente a la laparoscópica fueron: OR ajustado de complicaciones: 2,02 (IC95% 0,94-4,37); conversión quirúrgica (tasa): 3,2%; estancia: 2,2 Vs. 1,6,p=0,003; reincorporación a cotidianidad: 32,5 Vs. 9,6, p<0,001; duración quirúrgica: 22 minutos (p<0,001) menor en la colecistectomía abierta; desde la perspectiva del tercer pagador, costo promedio: US$995 Vs. US$ 1.048; incremento del costo-efectividad: US$ 7,4 favoreciendo la laparoscópica; desde la perspectiva paciente, costo promedio: US$ 53.2 Vs. US$ 104,8; incremento del costo-efectividad: US$-7.3 favoreciendo la laparoscópica; cero mortalidad. La variable que más impactó tiene en la toma de decisiones en términos de costos es el costo del procedimiento quirúrgico. Conclusiones. Hubo mayor estancia hospitalaria en la colecistectomía abierta frente a la mayor duración quirúrgica en la laparoscópica; en el costo directo de la laparoscópica: menor para IPS y pacientes; y en costo-efectividad equiparable para ambos procedimientos.

Introduction. Cholecystectomy has been the subject of several clinical and cost comparison studies. Objective. The results of open or laparoscopy cholecystectomy were compared in terms of cost and effectiveness from the perspective of health care institutions and from that of the patients. Materials and methods. The cost-effectiveness study was undertaken at two university hospitals in Bogotá, Colombia. The approach was to select the type of cholecystectomy retrospectively and then assess the result prospectively. The cost analysis used the combined approach of micro-costs and daily average cost. Patient resource consumption was gathered from the time of surgery room entry to time of discharge. A sample of 376 patients with cholelithiasis/cystitis (May 2005-June 2006) was selected--156 underwent open cholecystectomy and 220 underwent laparoscopic cholecystectomy. The following data were tabulated: (1) frequency of complications and mortality, post-surgical hospital stay, (2) reincorporation to daily activities, (3) surgery duration, (4) direct medical costs, (5) costs to the patient, and (6) mean and incremental cost-effectiveness ratios. Results. Frequency of complications was 13.5% for open cholecystectomy and 6.4% for laparoscopic cholecystectomy (p=0.02); hospital stay was longer in open cholecystectomy than in laparoscopic cholecystectomy (p=0.003) as well as the reincorporation to daily activities reported by the patients (p<0.001). The duration of open cholecystectomy was 22 min longer than laparoscopic cholecystectomy (p<0.001). The average cost of laparoscopic cholecystectomy was lower than open cholecystectomyand laparoscopic cholecystectomy was more cost-effective than open cholecystectomy (US$ 995 vs. US$ 1,048, respectively). The patient out-of-pocket expenses were greater in open cholecystectomy compared to laparoscopic cholecystectomy (p=0.015). Mortality was zero. Conclusions: The open laparoscopy procedure was associated with longer hospital stays, where asthe cholecystectomy procedure required a longer surgical duration. The direct cost of the latter was lower for both for the health care institution and patients. The cost-effectiveness for both procedures was comparable.

An economic evaluation of laparoscopic cholecystectomy for public hospitals in Trinidad and Tobago / Una Evaluación Económica de la Colecistectomía Laparoscópica para los Hospitales Públicos en Trinidad y Tobago

Laparoscopic Cholecystectomy (LC) is compared to the Open and Minilap approaches in a Cost Minimization Analysis for public hospitals in Trinidad and Tobago. The analysis shows that despite the high initial equipment cost required to perform LC, substantial savings can be achieved at the hospital level by converting from a minilap or open regime to a laparoscopic regime for cholecystectomy. Because of the reduced recovery period for the patient, LC represents further savings to other sectors of the economy as patients return to work much earlier after LC than after the other two approaches

La colecistectomía laparoscópica (CL) es comparado aquí con la cirugía abierta y la mini-laparotomía en un análisis de minimización de costos para los hospitales públicos en Trinidad y Tobago. El análisis muestra que a pesar del alto costo inicial del equipo requerido para realizar la CL, pueden lograrse ahorros sustanciales a nivel de hospital mediante la conversión del régimen de minilaparotomía o el de cirugía abierta a un régimen laparoscópico en la realización de la cole-cistectomía. En virtud de la reducción del periodo de recuperación de los pacientes, la CL representa ahorros ulteriores en otros sectores de la economía, ya que los pacientes regresan a sus trabajos en un espacio de tiempo mucho más corto, en comparación con lo que ocurre con las otras dos vías de acceso.

Laparoscopic cholecystectomy experience of 100 cases at a teaching hospital of Sindh

To study the complications, conversion rate and hospital stay during the initial experience with the laparoscopic cholecystectomy. A case series. Chandka Medical College Hospital, Larkana - Sindh from March 2003 to February 2004. Total 100 patients suffering from symptomatic gallstone disease were admitted for laparoscopic cholecystectomy. Out of 100 laparoscopic cholecystectomies performed, 85 [85%] patients were females and 15 [15%] males. Age range was 25 to 70 years. Only 8 [8%] patients were converted to open surgery. Mean operative time was 60 minutes. Post-operative hospital stay was 24 to 48 hours for uncomplicated cases. Post-operative complications included biliary leakage 3% minor and 1% major, duodenal perforation 1% and port site infection 8%. Laparoscopic cholecystectomy is the ideal procedure for gallstone disease. However, the complications and conversion rate can be minimized by the appropriate training and experience

Existe beneficio económico al realizar la colecistectomía laparoscópica? Análisis de las colecistectomías de CRAMI en 1999 / Is there an economic profit in performing laparoscopic cholecystectomy? Analysis of cholecystectomies performed in CRAMI during 1999

Se presentan 107 colecistectomías realizadas en CRAMI por patología litiásica durante el año 1999. 52 fueron realizadas por abordaje videolaparoscópico y 55 por técnica abierta, 24 de ellas en la urgencia. El tiempo de internación fue de 1.04 días para la colecistectomía laparoscópica y de 3.06 y 4.04 para la convencional de coordinación y urgencia respectivamente. Se utilizaron 5 veces menos analgésicos y antibióticos en los pacientes operados por vía laparoscópica.

Costo beneficio de la colecistectomía laparoscópica / Cost-benefit of the laparoscopic cholecistectomy

La colecistectomía laparoscópica presenta una relación costo beneficio muy favorable gracias a que incorpora la tecnología moderna en la colecistectomía. Esto significa un mayor costo del acto quirúrgico en sí mismo a nivel de pabellón por necesidad de equipos e instrumental quirúrgico nuevos y uso de material desechable, pero ello es compensado por menos días de hospitalización y fundamentalmente por menos días de ausencia laboral, por lo que el gasto para el país por concepto de tratamiento de la colelitiasis se reduce significativamente y a su vez permite grandes avances para el paciente

Laparoscopic cholecystectomy in Jamaica: the initial experience

This review of all laparoscopic cholecystectomies performed between 1993 and 1995 in Jamaica records the experience of local surgeons following an accelerated training programme. Special attention was paid to operating time, conversions, complications, analgesic requirements, time to discharge and cost. Comparisons were made of the local experience with the international experience. Laparoscopic cholecystectomy has been found to be a safe and viable option for Jamaican patients with gall bladder disease.

Colecistectomía Mínimamente Invasiva: Evaluación de Costos / Minimun Invasive Cholecystectomy: Cost evaluation

Se presenta un estudio prospectivo, de 20 pacientes portadores de litiasis vesicular, sometidos a protocolo de estudio y tratamiento, mediante colecistectomía mínimamente invasiva. Demostramos que: -Con esta técnica el trauma quirúrgico es mínimo. -El período de hospitalización de los pacientes fué de 24 a 28 hrs, y la reincorporación a sus labores fué al 8vo. día. Necesitaron solo consultas de control de post operatorio(3ero. y 7mo. día). -El costo comparativo con la colecistectomía laparoscópica es de 47 por ciento menos, y los resultados tanto cosméticos como, de comfort del paciente son similares.