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Impact of laparoscopic cholecystectomy: A population-based study

Lookup NU author(s): Dr Colin Fischbacher

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Abstract

Background. We assessed the effect of the introduction of laparoscopic cholecystectomy on surgical outcomes in routine practice. Methods Hospital discharge and death-certificate data were linked for all patients undergoing cholecystectomy (n=85 120) in Scottish public-sector hospitals (n=51) between January, 1981, and June, 1999. The primary endpoints were cholecystectomy rate, hospital stay, and postoperative mortality. Regression methods were used to examine the effect of laparoscopic experience and surgeon caseload on postoperative mortality and hospital stay. Findings. From 1989 to 1999, the proportion of cholecystectomies done laparoscopically rose from none to 80%, and the age-standardised cholecystectomy rate increased by 20% (95% Cl 15-26). Postoperative mortality did not change in the 1990s (odds ratio 0.99 [0.7-1.4], p=0.99). The mean postoperative hospital stay fell from 8.0 (SD 3.7) to 2.9 (3.2) days. There was wide variation between hospitals in the proportion of cholecystectomies done laparoscopically and in average hospital stay. For individual surgeons, increasing laparoscopic experience and annual caseload were associated with higher proportions of laparoscopic procedures and shorter hospital stays. Postoperative mortality was higher during the first ten laparoscopic cholecystectomies done by a surgeon (compared with >200 procedures, odds ratio 2.3 [1.2-4.6], p=0.015). Interpretation. The laparoscopic method reduced hospital stay but had no overall effect on postoperative mortality. Studies to assess the appropriateness of the increased cholecystectomy rate are merited. The wide variation in the proportion done laparoscopically, together with evidence of better results for surgeons doing more procedures, suggests scope for further reductions in hospital stay and morbidity.

Publication metadata

Author(s): McMahon AJ, Fischbacher CM, Frame SH, MacLeod MCM

Publication type: Article

Publication status: Published

Journal: Lancet

Year: 2000

Volume: 356

Issue: 9242

Pages: 1632-1637

ISSN (print): 0140-6736

ISSN (electronic): 1474-547X

Publisher: The Lancet Publishing Group

URL: http://dx.doi.org/10.1016/S0140-6736(00)03156-1

DOI: 10.1016/S0140-6736(00)03156-1

PubMed id: 11089821

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