Senior Scholars Program

Title

Surgeon Volume Metrics in Laparoscopic Cholecystectomy

UMMS Affiliation

Department of Surgery

Faculty Advisor

Shah, Shimul A.

Date

8-13-2010

Document Type

Article

Medical Subject Headings

Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Gallbladder; Propensity Score; Outcome Assessment (Health Care); Surgery Department, Hospital

Disciplines

Life Sciences | Medicine and Health Sciences | Surgery

Abstract

AIM: Numerous reports in the 1990s pointed to a learning curve for laparoscopic cholecystectomy (LC), critical in achieving excellent outcomes. As LC is now standard therapy for acute cholecystitis (AC), we aimed to determine if surgeon volume is still vital to patient outcomes.

METHODS: The Nationwide Inpatient Sample was used to query 80,149 emergent/urgent cholecystectomies performed for AC from 1999 to 2005 in 12 states with available surgeon/hospital identifiers. Volume groups were determined based on thirds of number of cholecystectomies performed per year for AC; two groups were created [low volume (LV): 15/year]. Primary endpoints were the rate of open conversion, bile duct injury (BDI), in-hospital mortality, and prolonged length of stay (LOS). Propensity scores were used to create a matched cohort analysis. Logistic regression models were created to further assess the effect of surgeon volume on primary endpoints.

RESULTS: The number of cases performed by HV surgeons increased from 24% to 44% from 1999 to 2005. HV surgeons were more likely to perform LC, had fewer conversions, lower incidence of prolonged LOS, lower BDI, and lower in-hospital mortality. After matching the volume cohorts to create a case-controlled analysis, multivariate analysis confirmed that surgeon volume was an independent predictor of open conversion and prolonged LOS but not BDI and in-hospital mortality.

CONCLUSIONS: Increasing surgical volume remains associated with improved outcomes after surgery during emergent/urgent admission for AC with fewer open conversions and prolonged LOS. Our results suggest that referral to HV surgeons has improved outcomes after LC for AC.

Rights and Permissions

Citation: Dig Dis Sci. 2010 Aug;55(8):2398-405. Epub 2009 Nov 13.

Related Resources

Link to article in PubMed

Comments

Medical student Anand Singla participated in this study as part of his Senior Scholars research project.

PubMed ID

19911275