Fewer Procedures, Lower Cost: The Intermountain Healthcare Experience
This large real-world analysis from Intermountain HealthCare quantifies what single-stage management actually delivers. Among 1,961 patients treated for common bile duct stones across 22 hospitals, those managed with cholecystectomy plus laparoscopic common bile duct exploration underwent the fewest procedures (mean 1.4 vs 2.1 for postoperative ERCP and 2.3 for preoperative ERCP), generated the lowest hospital charges ($9,000 vs $10,800 and $14,200), and had the shortest stay (2.2 vs 3.2 and 4.3 days) — all without an increase in complications. The authors’ conclusion is direct: single-stage management “resulted in the fewest procedures and lower hospital charges without an increase in complications.” The unmet-need signal is equally direct: just 28% of patients received it.
Citation
Gilsdorf D, Henrichsen J, Liljestrand K, et al. Laparoscopic common bile duct exploration for choledocholithiasis: analysis of practice patterns of Intermountain HealthCare. J Am Coll Surg. 2018;226(6):1160-1165. doi:10.1016/j.jamcollsurg.2018.02.008
