Cost and morbidity of surgical management of resectable gallbladder cancer (GBC): Results from the National Inpatient Sample database.

Abstract

e15663 Background: GBC is the most common biliary tract cancer. Based on a retrospective, single-institution data, extended cholecystectomy (EXT) has been recommended over simple cholecystectomy (CHOL) in tumors T2 and above. Retrospective data indicate increased morbidity/mortality with removal of more than 3 segments of the liver compared to CHOL and the effect on long-term survival is unclear. Therefore, we sought to identify short-term outcomes of hospitalization, such as cost and morbidity, for surgical treatment of GBC. Methods: The National Inpatient Sample/Healthcare Cost and Utilization Project (NIS/HCUP) for years 2010, 2011, 2012 and 2013 was surveyed for GBC hospitalizations. Hospitalizations for non-surgical management of GBC were excluded. Results: We identified 5,612 cases; mean age in EXT was 66.8 years vs. 72.4 in CHOL (p<0.001). Patients insured through Medicare were less likely to have EXT (OR: 1.5, 95% CI 1.125-2.064; p=0.007). No difference based on race (OR: 1.14, 95% CI 0.854-1.519; p=0.38). Surgical/Medical morbidity is presented in Table 1. In-hospital mortality was 3.3 vs. 4.1% for EXT and CHOL, respectively (p=0.55). Mean length of stay was higher in the EXT group (9.8 vs. 8.3 days, p=0.03), cost ($32,782 vs. 22,667.3, p=0.003) and total charges ($111,714.7 vs. 81,432.9, p<0.001). Conclusions: EXT for resectable GBC is associated with higher cost of care, probably related to higher risk for surgical site infection and stump leak. Until more evidence for overall survival benefit from EXT in this rare tumor emerges, referral of patients to high-volume centers with the hepatobiliary surgery expertise is recommended. [Table: see text]