Identifying the causes of the high incidence of cholelithiasis and a health economics evaluation of two types of cholecystectomies in Qinghai province

Abstract

AbstractBackground:Qinghai province has a high incidence of cholelithiasis. However, the risk factors for cholelithiasis in a high-altitude area remain unclear. It is urgent to formulate and promote the diagnosis and treatment norms of this disease.Objective:We explored the causes of the high incidence of cholelithiasis in a high-altitude area to assess the clinical and economical differences between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC), two surgical approached to treat cholelithiasis, and to establish a risk prediction model.Methods:In this retrospective study, we enrolled 8,596 patients to explore the spatiotemporal distribution of the disease. We ultimately selected 3,914 treated with cholecystectomy: 64 received OC and 3,850 received LC. We evaluated differences in clinical factors and health economics between the groups by using Student’s t-test and the chi-square test. We used multivariate analysis of variance and step regression to identify the risk factors of cholelithiasis.Results:There were significantly fewer cases in spring than in winter (p= 0.001). There were significant differences in age, surgical expenses, total expenses, and length of stay between the OC and LC groups (p= 0.001). The step regression model revealed that the risk factors for cholelithiasis are the surgical approach, age, sex and the outcome after hospital discharge.Conclusion:In Qinghai province, the incidence of cholelithiasis was higher in winter. Compared with OC, LC showed better performance from both the clinical and economical points of views. Besides, the prediction model demonstrated that the surgical approach, sex, age and the outcome after discharge affect the prognosis for patients with cholelithiasis.