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A cost analysis of operative repair of major laparoscopic bile duct injuries

Stefan Hofmeyr, Jake E J Krige, Philippus C Bornman, Steve J Beningfield

Abstract


Background. Major bile duct injuries occur infrequently after laparoscopic cholecystectomy, but may result in life-threatening complications. Few data exist on the financial implications of duct repair. This study calculated the costs of operative repair in a cohort of patients who underwent reconstruction of the bile duct after major ductal injury.

Objective. To calculate the total in-hospital cost of surgical repair of patients referred with major bile duct injuries.

Methods. A prospective database was reviewed to identify all patients referred to the University of Cape Town Private Academic Hospital, South Africa, between 2002 and 2013 for assessment and repair of major laparoscopic bile duct injuries. The detailed clinical records and billing information were evaluated to determine all costs from admission to discharge. Total costs for each patient were adjusted for inflation between the year of repair and 2013.

Results. Forty-four patients (33 women, 11 men; median age 48 years, range 30 - 78) underwent reconstruction of a major bile duct injury. First-time repairs were performed at a median of 24.5 days (range 1 - 3 662) after initial surgery. Median hospital stay was 15 days (range 6 - 86). Mean cost of repair was ZAR215 711 (range ZAR68 764 - 980 830). Major contributors to cost were theatre expenses (22%), admission to intensive care (21%), radiology (17%) and specialist fees (12%). Admission to a general ward (10%), consumables (7%), pharmacy (5%), endoscopy (3%) and laboratory costs (3%) made up the balance.

Conclusions. The cost of repair of a major laparoscopic bile duct injury is substantial owing to prolonged hospitalisation, complex surgical intervention and intensive imaging requirements.


Authors' affiliations

Stefan Hofmeyr, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Surgical Gastroenterology Unit, Groote Schuur Hospital, and University of Cape Town Private Academic Hospital, Cape Town, South Africa

Jake E J Krige, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Surgical Gastroenterology Unit, Groote Schuur Hospital, and University of Cape Town Private Academic Hospital, Cape Town, South Africa

Philippus C Bornman, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa; Surgical Gastroenterology Unit, Groote Schuur Hospital, and University of Cape Town Private Academic Hospital, Cape Town, South Africa

Steve J Beningfield, Department of Radiology, Faculty of Health Sciences, University of Cape Town, South Africa

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Keywords

Cost analysis; Bile duct injury; Laparoscopic cholecystectomy

Cite this article

South African Medical Journal 2015;105(6):454-457. DOI:10.7196/SAMJ.9038

Article History

Date submitted: 2015-09-18
Date published: 2015-09-18

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