Elective laparoscopic cholecystectomy: implications of prolonged waiting times for surgery

Abstract

Background: The aim of the present study was to assess the impact of surgical waiting times on patients scheduled for elective laparoscopic cholecystectomy (LC), with emphasis on morbidity and costs incurred.

Methods: A retrospective review of all patients who underwent cholecystectomy at the Launceston General Hospital between 1 January 1999 and 31 December 2001 was performed.

Results: A total of 322 LCs was performed during the study period. Median time on the waiting list was 130 (1-1481) days. While awaiting surgery, 44/322 patients (14%) re-presented to the emergency department with biliary symptoms (89 separate presentations); 21 patients (6%) were admitted (28 admissions), of whom 18 (86%) were on the waiting list for biliary colic symptoms only. Reasons for emergency admission included pancreatitis (1), cholangitis (3), choledocholithiasis (7), cholecystitis (7), and exacerbation of symptoms (10). Median hospital stay was 4 days (1-14 days) (total cost of 124 hospital days, excluding subsequent admission for cholecystectomy, $A128 712 according to average bed day costs), and 11 patients required endoscopic retrograde cholangiopancreatography (13 procedures). Mean (median) time on the surgical waiting list for patients who developed complications was 238 (203) days versus 185 (126) days for patients who had LC without interval complications. A total of 198 cancellations occurred in 124/322 patients (39%) before surgery.

Conclusions: Prolonged waiting times for elective LC are associated with morbidity in 14% of patients at the Launceston General Hospital. This, combined with frequent cancellation of elective surgery, may result in significant costs to the health-care sector.