Cost and outcomes of open versus laparoscopic cholecystectomy in Mongolia.
J Surg Res
; 229: 186-191, 2018 09.
Article
em En
| MEDLINE
| ID: mdl-29936988
ABSTRACT
BACKGROUND:
Laparoscopic cholecystectomy (LC) is the standard of care for biliary disease in developed countries. LC in resource-limited countries is increasing. This prospective, observational study evaluates costs, outcomes, and quality of life (QoL) associated with laparoscopic versus open cholecystectomy (OC) in Mongolia.METHODS:
Patient demographics, outcomes, and total payer and patient costs were elicited from a convenience sample of patients undergoing cholecystectomy at four urban and three rural hospitals (February 2016-January 2017). QoL was assessed preoperatively and postoperatively using the five-level EQ-5D instrument. Perioperative complications, surgical fees, and QoL scores were evaluated for LC versus OC. Multivariate regression models were generated to adjust for differences between these groups.RESULTS:
Two hundred and fifteen cholecystectomies were included (LC 122, OC 93). LC patients were more likely to have attended college and have insurance. Preoperative symptoms were comparable between groups. Total complication rate was 21.8% (no difference between groups); LC patients had less superficial infections (0% versus 10.8%). Median hospital length of stay (HLOS) and days to return to work were shorter after LC. QoL improved after surgery for both groups. Mean total payer and patient costs were higher for LC, but not significant (P-value 0.126). After adjustment, LC had significantly less complications, shorter HLOS, fewer days to return to work, greater improvement in QoL scores, and no increase in cost.CONCLUSIONS:
LC is safe and beneficial to patients with biliary disease in Mongolia, and cost effective from the patient's and payer's perspective. Although equipment costs for LC may be more expensive than OC, there are likely significant cost savings related to reduced HLOS, shorter time off work, fewer complications, and improved QoL.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Doenças Biliares
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Análise Custo-Benefício
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Colecistectomia Laparoscópica
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Período Perioperatório
Tipo de estudo:
Etiology_studies
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Health_economic_evaluation
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
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Middle aged
País como assunto:
Asia
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article