Cost-Benefit Analysis of Various Management Algorithms for Suspected Choledocholithiasis

The goal of our study is to evaluate the safest, efficient, and most cost-effective way to manage suspected choledocholithiasis. This retrospective study evaluated adult patients with suspected choledocholithiasis based on labs and imaging at a single institution between 2017 and 2022 and characterized them into 1 of 3 groups based on their management pathway: (1) ERCP-first, (2) MRCP-first, or (3) surgery-first with possible intraoperative cholangiogram pending laboratory trend. Our primary outcome was hospital length of stay. 34 patients (25%) had MRCP-first, 60 patients (45%) had ERCP-first, and 39 patients (30%) received surgery first. There was no statistically significant difference in the length of stay with respect to the management pathway utilized ( P > .05); however, those admitted to a surgical service were discharged on average one day before those admitted to the medicine service ( P = .01).