Increased Cholecystectomy Rate After the Introduction of Laparoscopic Cholecystectomy

Objective. —To examine if overall cost savings may fail to result from laparoscopic ("closed") cholecystectomy if it also results in an increased total rate of cholecystectomies or generates additional costs unassociated with the open procedure. Outcome Measures. —Inpatient and outpatient expenditures, incidence rates, and length of inpatient stay data for 6909 health maintenance organization enrollees with gallbladder complaints were analyzed from 1988 through 1992 using claims data from a large, private practice—based health maintenance organization. Results. —The incidence of cholecystectomy and total health maintenance organization expenditures on gallbladder disease have increased since the introduction of laparoscopic closed cholecystectomy. The rate of cholecystectomy procedures per 1000 enrollees increased from 1.35 in 1988 to 2.15 in 1992 ( P P P Conclusions. —The introduction of laparoscopic gallbladder surgery resulted in rising rates of cholecystectomy for a population of patients in a private, independent practice—based health maintenance organization. Such a rise was not seen for hernia repair surgery or appendectomy. It seems that the use of laparoscopic cholecystectomy, a new technology touted as reducing health care costs, may result in an increased consumption of health care resources due to changes in the indications for gallbladder surgery. ( JAMA . 1993;270:1429-1432)