Costos de las diversas modalidades posoperatorias de la colecistectomía laparoscópica. Cooperativa Médica de Florida (COMEF), 2016-2021

Daniel González González

doi:10.29193/RMU.38.3.5

Authors

Daniel González González Universidad de la República, Facultad de Medicina, Clínica Quirúrgica 3, Profesor Titular. COMEF, Departamento de Cirugía, Jefe

DOI:

https://doi.org/10.29193/RMU.38.3.5

Keywords:

LAPAROSCOPIC CHOLECYSTECTOMY, AMBULATORY MAJOR SURGERY, COSTS

Abstract

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.

References

1) Bueno Lledó J, Planells Roig M, Arnau Bertomeu C, Sanahuja Santafé A, Oviedo Bravo M, García Espinosa R, et al. Colecistectomía laparoscópica ambulatoria: ¿El nuevo “gold standard” de la colecistectomía?. Rev Esp Enferm Dig 2006; 98(1):14-24. doi: 10.4321/s1130-01082006000100003.
2) Lezana Pérez MÁ, Carreño Villarreal G, Lora Cumplido P, Alvarez Obregón R. Colecistectomía laparoscópica ambulatoria versus con ingreso: estudio de efectividad y calidad. Cir Esp 2013; 91(7):424-31. doi: 10.1016/j.ciresp.2012.10.010.
3) Bonilla F, Almada M, Canessa C. Cirugía del día: colecistectomía laparoscópica. Rev Méd Urug 2016; 32(4):274-80. Disponible en: http://www.scielo.edu.uy/pdf/rmu/v32n4/v32n4a06.pdf [Consulta: 24 noviembre 2021].
4) Teixeira UF, Goldoni MB, Machry MC, Ceccon PN, Fontes PR, Waechter FL. Ambulatory laparoscopic cholecystectomy is safe and cost-effective: a Brazilian single center experience. Arq Gastroenterol 2016; 53(2):103-7. doi: 10.1590/S0004-28032016000200010.
5) Manzia TM, Quaranta C, Filingeri V, Toti L, Anselmo A, Tariciotti L, et al. Feasibility and cost effectiveness of ambulatory laparoscopic cholecystectomy. A retrospective cohort study. Ann Med Surg (Lond) 2020; 55:56-61. doi: 10.1016/j.amsu.2020.04.036.
6) Victorzon M, Tolonen P, Vuorialho T. Day-case laparoscopic cholecystectomy: treatment of choice for selected patients?. Surg Endosc 2007; 21(1):70-3. doi: 10.1007/s00464-005-0787-0.
7) Calland JF, Tanaka K, Foley E, Bovbjerg VE, Markey DW, Blome S, et al. Outpatient laparoscopic cholecystectomy: patient outcomes after implementation of a clinical pathway. Ann Surg 2001; 233(5):704-15. doi: 10.1097/00000658-200105000-00015.
8) Montico E, Velarde M. Una propuesta de costos para las instituciones de asistencia médica colectiva. Costos por paciente y patología. Disponible en: https: www.monografías.com >trabajos14 > costos-iamc [Consulta: 24 noviembre 2021].