Long waiting lists and avoidable complications: the example of cholecystectomy

Background: Cholecystectomy is between the surgical procedures with a longer waiting list and a significative proportion of patients waiting surgery suffer from symptoms related to complications of cholelithiasis. The aim of this study is to evaluate the mean waiting time for elective cholecystectomy and the economic impact that the waiting list creates. Material and Methods: A retrospective and comparative study for patients undergoing intervention of cholecystectomy in a period between April 2007 and April 2010 was performed. Patients who had a pre-operative period without complications (group A) and patients who required unplanned admissions, additional diagnostic tests (group B), and operations in emergency (group C) were analyzed. Regional tariff of outpatient specialist care and hospital care was used. Results: 86 patients were included in the study: 67 (78%) in the group A, 7 (8.1%) in the group C and 12 (13.9%) in the group B. The mean waiting time before surgery was: 192 days for group A, 134 days for group B and 44 days for group C. Overall cost of health care expenditure for each patients was: 3857,44 € for group A, 7041,98 € for group B and 4062,65 € for group C. Patients in group B had a statistically significant longer hospital stay compared to patients in group A and C. Conclusion: Early laparoscopic cholecystectomy for complicated cholelithiasis is the cheaper treatment considering the health care costs and reduced the social costs related to the absence from work and the deterioration in the perception of quality of life.