Trends and Factors Impacting Healthcare Charges and Length of Stay for Cholecystectomies: A New York State Population-based Analysis
Keywords:Cholecystectomy, Laparoscopy, Lenght of stay, Gallbladder diseases, Healthcare costs
Background: Gallbladder disease confers a significant economic toll on the United States healthcare system. This study aims to characterize current trends and features of the cholecystectomy population and identify factors that influence the length of stay and total charges.
Methods: Case information was extracted for laparoscopic and open cholecystectomies from 2013-2016 using the New York Statewide Planning and Research Cooperative System (SPARCS) database. Descriptive, comparative, and multivariable linear regression analysis was conducted on 58,141 cases assessing age group, race, gender, admission presentation, surgical technique, insurance status, year of operation and severity of illness by the length of stay and total charges.
Results: Of all procedures, 91.6% were laparoscopic, and 79.4% were emergent on admission. Total procedures trended down, while laparoscopic and emergent cases steadily increased (p<0.0001). Total charges increased during the study period, while the length of stay decreased (p<0.0001). Open and emergent procedures were associated with a higher cost and longer inpatient stays (p<0.0001). Open procedures were proportionally more common among elderly, male patients, and in elective cases (p<0.0001). Emergent presentation was more common in females, non-whites, and younger patients (p<0.0001). Regression model showed that male gender, open operation, Black race, and emergent presentation were independent predictors for a longer stay and greater total charges (p<0.0001). Medicare insurance predicted lower total charges but longer length of stay (p<0.0001).
Conclusion: Race, insurance, procedure type, and patient presentation influence hospital charges and stays following cholecystectomy. Understanding these trends will allow policymakers and providers to limit the healthcare burden of cholecystectomy.
McDermott K, Freeman WJ, Elixhauser A. Overview of Operating Room Procedures During Inpatient Stays in U.S. Hospitals. Healthcare Cost And Utilization Project. 2014; 2017, 1-18.
Halpin V. Acute cholecystitis. BMJ Clin Evid. 2014 Aug:04-11.
Carbonell AM, Lincourt AE, Kercher KW, Matthews BD, Cobb WS, Sing RF, Heniford BT. Do patient or hospital demographics predict cholecystectomy outcomes? A nationwide study of 93,578 patients. Surg Endosc. 2005 Jun;19, 767-73.
Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: Cholelithiasis and cancer. Gut Liver. 2012 Apr;6(2):172-87.
Shaffer EA. Epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol. 2006;20(6):981-96.
Sandblom G, Videhult P, Crona Guterstam Y, Svenner A, Sadr-Azodi O. Mortality after a cholecystectomy: A population-based study. HPBA. 2015;17, 239-243.
Shea JA, Healey MJ, Berlin JA, et al. Mortality and complications associated with laparoscopic cholecystectomy: A meta-analysis. Ann Surg. 1996; 224(5), 609-620.
Fogli L, Boschi S, Patrizi P, et al. Laparoscopic cholecystectomy without intraoperative cholangiography: Audit of long-term results. J Laparoendosc Adv Surg Tech. 2009;2, 191-3.
Livingston EH, Rege R V. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg. 2004;188, 205-211.
Reynolds W Jr. The first laparoscopic cholecystectomy. JSLS. 2001;5(1):89-94.Bates AT, Divino C. Laparoscopic surgery in the elderly: A review of the literature. Aging Dis. 2015;6, 149-155.
Lujan JA, Parrilla P, Robles R, Marin P, Torralba JA, Garcia-Ayllon J. Laparoscopic cholecystectomy vs open cholecystectomy in the treatment of acute cholecystitis: A prospective study. Arch Surg. 1998; 133, 173-175.
Alli VV, Yang J, Xu J, Bates AT, Pryor AD, Talamini MA, Telem DA. Nineteen-year trends in incidence and indications for laparoscopic cholecystectomy: the NY State experience. Surg Endosc. 2017;31, 1651-1658.
Polomsky M, Hu R, Sepesi B, O'Connor M , Qui X , Raymond DP, Litle VR, Jones CE, Watson TJ, Peters JH. A population-based analysis of emergent vs. elective hospital admissions for an intrathoracic stomach. Surg Endosc. 2010;24, 1250-1255.
Bureau of Health Informatics Office of Quality and Health Safety. Statewide Planning and Research Cooperative System (SPARCS). New York State Department of Health.
Thompson DA, Makary MA, Dorman T, Pronovost PJ. Clinical and economic outcomes of hospital acquired pneumonia in intra-abdominal surgery patients. Ann Surg. 2006;243, 547-552.
Chi M Ju, Lee C Yi, Wu S Chong. The prevalence of chronic conditions and medical expenditures of the elderly by chronic condition indicator (CCI). Arch Gerontol Geriatr. 2011;52(3), 284-289.
Moy E, Coffey RM, Moore BJ, Barrett ML, Hall KK. Length of stay in EDs: Variation across classifications of clinical condition and patient discharge disposition. Am Journal Emerg Med. 2016;1, 83-7.
McCormick PJ, Lin H Mo, Deiner SG, Levin MA. Validation of the All Patient Refined Diagnosis Related Group (APR-DRG) Risk of Mortality and Severity of Illness Modifiers as a Measure of Perioperative Risk. J Med Syst. 2018;42(5), 81.
Wadhwa V, Jobanputra Y, Garg SK, Patwardhan S, Mehta D, Sanaka MR. Nationwide trends of hospital admissions for acute cholecystitis in the United States. Gastroenterol Rep. 2017;5, 36-42.
To KB, Cherry-Bukowiec JR, Englesbe MJ, Terjimanian MN, Shijie C, Campbell Jr. DA, Napolitano LM. Emergent versus elective cholecystectomy: Conversion rates and outcomes. Surgical Infections. 2013;14(6), 512-9.
Andercou O, Olteanu G, Mihaileanu F, Stancu B, Dorin M. Risk factors for acute cholecystitis and for intraoperative complications. Annali Italiani Di Chirurgia. 2017;88, 318-325.
Safran DB, Orlando R. Physiologic effects of pneumoperitoneum. Am J Surg. 1994;167, 281-286.
Ho HS, Gunther RA, Wolfe BM. Intraperitoneal Carbon Dioxide Insufflation and Cardiopulmonary Functions: Laparoscopic Cholecystectomy in Pigs. Arc Surg. 1992;127(8), 888-892.
Hirvonen EA, Nuutinen LS, Kauko M. Ventilatory effects, blood gas changes, and oxygen consumption during laparoscopic hysterectomy. Anesth Analg. 1995;80(5), 961-966.
Ferrarese AG, Solej M, Enrico S, Falcone A, Catalano S, Pozzi G, Marola S, Martino v. Elective and emergency laparoscopic cholecystectomy in the elderly: Our experience. BMC Surgery. 2013;13, S21.
Musbahi A, Abdulhannan P, Bhatti J, Dhar R, Rao M, Gopinath B. Outcomes and risk factors of cholecystectomy in high risk patients: A case series. Ann Med Surg (Lond). 2020;50, 35-40.
Bazoua G, Tilston MP. Male gender impact on the outcome of laparoscopic cholecystectomy. JSLS. 2014;18(1), 50-4.
Alqahtani R, Ghnnam W, Alqahtani M, Qatomah A, AlKhathami A, Alhashim A. Role of Male Gender In Laparoscopic Cholecystectomy Outcome. Int J Surg Med. 2015;1(2), 38-42.
Gahagan JV, Hanna MH, Whealon MD, Maximus S, Phelan MJ, Lekawa M, Barrios C, Bernal NP. Racial disparities in access and outcomes of cholecystectomy in the United States. Am Surg. 2016;82(10), 921-925.
How to Cite
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to email@example.com
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to firstname.lastname@example.org