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COMPARISON OF AVERAGE COST BETWEEN EARLY VERSUS DELAYED LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS

Dr. Aamir Javid, Dr. Tajwer Zaman, Dr. Ayesha Gull

Background: Acute cholecystitis is an acute inflammation of gallbladder. It is a major complication of gallstones and is diagnosed in 10% to 35% of patients admitted for cholecystectomy. Delayed laparoscopic cholecystectomy was considered as gold standard treatment of acute cholecystitis. Several randomized studies have shown that early open cholecystectomy for acute cholecystitis is as safe as delayed open cholecystectomy with reduced morbidity and hospital stay, lower costs, and rapid recovery. Objectives of study were to compare the average cost of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy in patients with acute cholecystitis.Materials and Methods: It was a randomized controlled trial conducted at Surgical Unit II, Nishtar Hospital, Multan. Duration of study was 6 months. There were 100 patients enrolled with 50 in each group. Non-probability consecutive sampling was used. Total 100 patients with acute cholecystitis fulfilling the inclusion and exclusion criteria were admitted from OPD and emergency department of Nishtar Hospital Multan. Patients of acute cholecystitis were divided in two groups blindly by envelop method. Group A underwent early laparoscopic cholecystectomy while Group B underwent delayed laparoscopic cholecystectomy. All surgeries were done by surgeons with at least 5 year laparoscopic experience to avoid bias. Average cost was measured as the sum of total expenditure from day of admission to day of discharge [pre op medicine and post op medicine, investigations and surgical material used]. All the data was recorded in the especially designed Proforma.Results: There were 100 patients in total. Males were 40 [40%] while females were 60 [60%]. Mean age was 51.81 + 12.614. Mean cost of pre-operative medication was 1828.20 + 605.98 Rupees. Mean cost of preoperative investigations was 2197.35 + 883.806 Rupees. Mean cost of surgical material was 3862.95 + 728.08. Mean cost of anesthesia was 2046.70 + 725.89 rupees. Mean cost of post operative medication was 3124.42 + 1307.62. Mean for total cost was 13060.27 + 4099.97. In treatment group A, mean cost of preoperative medication, preoperative investigations, surgical material cost, anesthesia medication cost, postoperative medicine cost and total mean cost were 1246.80 + 140.951, 1362 + 274.472, 3186.50 + 245.78, 1344.70 + 163.87, 1913.40 + 479.33 and 9054.60 + 718.07 rupees while the costs in treatment group B were 2409.60 + 179.446, 3032.70 + 280.59, 4539.40 + 277.08, 2748.70 + 178.97, 4335.44 + 481.56 and 17065.94 + 837.45 rupees respectively [p-value < 0.0001].Conclusion: Early laparoscopic cholecystectomy is significantly cost-effective procedure as compared to late laparoscopic cholecystectomy and keeping in view similar safety profile and success rates of both procedures in the literature, early laparoscopic cholecystectomy should be the preferred treatment option for patients with acute cholecystitis. Keywords: Early Laproscopic Cholecystectomy, Delayed Laparoscopic Cholecystectomy, Acute Cholecystitis.

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