A current profile and assessment of north american cholecystectomy: results from the american college of surgeons national surgical quality improvement program.
BACKGROUND
Cholecystectomy is among the most common surgical procedures performed in the United States. The current state of cholecystectomy outcomes, including variations in hospital performance, is unclear. The objective of this study is to compare the risk factors, indications, and 30-day outcomes, as well as variations in hospital performance associated with laparoscopic (LC) versus open cholecystectomy (OC) at 221 hospitals during a 4-year period.


METHODS
Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2005-2008), patients were identified who underwent cholecystectomy and related procedures (cholangiogram and/or common bile duct exploration). Four outcomes were studied, ie, 30-day overall morbidity, serious morbidity, surgical site infections, and mortality. Forward stepwise logistic regressions yielded patient-level predicted probabilities, and hospital-level observed-to-expected ratios were determined.


RESULTS
Of 65,511 patients, 58,659 (89.5%) underwent LC; 6,852 (10.5%) underwent OC. OC patients were considerably older with a higher comorbidity burden. LC patients were less likely to experience any morbidity (3.1% versus 17.8%; p < 0.0001), a serious morbidity (1.4% versus 11.1%; p < 0.0001), or a surgical site infection (1.3% versus 8.4%; p < 0.0001), and less likely to die (0.3% versus 2.8%; p < 0.0001). Observed-to-expected ratios for overall morbidity ranged from 0 to 3.55; for serious morbidity, 0 to 3.23; for surgical site infection, 0 to 7.02; for mortality, 0 to 13.05.


CONCLUSIONS
Although overall incidence of adverse events is low after LC, substantial morbidity and mortality are associated with OC. Additionally, controlling for patient- and operation-related factors, considerable variations exist in hospital performance when evaluating 30-day outcomes after cholecystectomy.
Ingraham
Angela M
AM
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA. aingraham@facs.org
Cohen
Mark E
ME
Ko
Clifford Y
CY
Hall
Bruce Lee
BL
D000328:Adult; D000368:Aged; D002763:Cholecystectomy / Q000592:standards*; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D015996:Survival Rate; D014481:United States / Q000453:epidemiology