389 Evaluating the Efficiency and Cost-Effectiveness of the Two-Stage Versus One-Stage Management of Common Bile Duct Stones

Abstract Aim Gallbladder disease is a prevalent surgical conditions, affecting approximately 15% of the population. Of these, about 15% develop common bile duct (CBD) stones. We have aimed to evaluate our current practice of managing this via ERCP followed by laparoscopy cholecystectomy (LC) looking at the operational and financial efficiency Method A retrospective review was conducted of patients undergoing the two-stage pathway (ERCP ± CBD stent ± stent removal followed by LC) between September 2023 and September 2024. Inclusion criteria covered all patients deemed fit for further surgical intervention. Data collected included demographics, admission type, timing and number of ERCPs, and surgical outcomes. Results Out of 500 patients screened, 61 met the inclusion criteria. The majority were female (77%), with a male-to-female ratio of 1:2.3. The mean age was 56.7 years (±15.9). The mean length of hospital stay was 6.5 days (±4.1), with a readmission rate of 11.7%. Ten patients had yet to undergo LC, and three had not had stent removal at the time of analysis. On average, each patient underwent 1.9 ERCPs. The cost for these 61 patients, based on national tariffs, was £350,233. Modelling suggests that a one-stage approach using LC + LCBDE could reduce this to approximately £160,000. Conclusions This review supports the growing body of evidence that a one-stage approach using LC + LCBDE offers greater clinical, and cost-efficiency compared to the traditional two-stage pathway. Where expertise and facilities allow, LC + LCBDE should be considered the standard of care to reduce healthcare costs, improve outcomes, and minimise patient burden.