November 12, 2014
Notes: Szwedziak, Krzysztof
Pol Przegl Chir. 2013 Mar;85(3):137-40. doi: 10.2478/pjs-2013-0024.
Reference Type: Journal Article
Record Number: 5281Author: Tabone, L. E., Conlon, M., Fernando, E., Yi, S., Sarker, S., Fisichella, P. M. and Luchette, F. A.
Title: A practical cost-effective management strategy for gallstone pancreatitis
Journal: Am J Surg
Short Title: A practical cost-effective management strategy for gallstone pancreatitis
Alternate Journal: American journal of surgery
ISSN: 1879-1883 (Electronic)
Accession Number: 23631907
Cholangiopancreatography, Endoscopic Retrograde/economics
Hospital Charges/*statistics & numerical data
Length of Stay/statistics & numerical data
Liver Function Tests
Abstract: BACKGROUND: The purpose of this study was to evaluate the outcomes of various surgeon strategies used to evaluate and treat common duct stones (CDSs) in patients presenting with mild to moderate gallstone pancreatitis (GP). METHODS: We performed a retrospective review of patients admitted for mild to moderate GP. Data variables included laboratory values and radiology images, indications for and findings of intraoperative cholangiogram (IOC) and endoscopic retrograde cholangiopancreatography (ERCP), length of stay (LOS), and hospital charges. Data were stratified by 2 different management strategies: preoperative ERCP and then laparoscopic cholecystectomy (LC) or LC with IOC followed by selective postoperative ERCP. RESULTS: During this time period, 80 patients met the study criteria, 56 were treated by LC with IOC, and 24 had a preoperative ERCP performed. The incidence of CDS was 33% (n = 26). The presence of CDSs correlated with an elevated total bilirubin at admission (CDSs 3.5 mg/dL vs 2.1 mg/dL no CDSs, P < .01) and 24 hours after admission (CDS 3.2 mg/dL vs 1.5 mg/dL no CDS, P < .01). Patients who had an IOC compared with those who had preoperative ERCP had a shorter LOS (4.6 vs 5.9 days, P = .04) and lower hospital charges (US $28,510 vs US $38,620; P < .01). CONCLUSIONS: Elevated total bilirubin at admission and 24 hours after admission may predict a patient’s risk for CDS. We found that the management of uncomplicated GP with early LC and IOC results in decreased LOS and total hospital charges when compared with preoperative ERCP.