title: Surgeon volume trumps specialty: outcomes from 3596 pediatric cholecystectomies.
abstract: BACKGROUND
  Laparoscopic cholecystectomy is the standard surgical management of biliary disease in children, but there has been a paucity of studies addressing outcomes after pediatric cholecystectomies, particularly on a national level. We conducted the first study to address the effect of surgeon specialty and volume on clinical and economic outcomes after pediatric cholecystectomies on a population level.
  
  
  METHODS
  We conducted a retrospective cross-sectional study using the Health Care Utilization Project Nationwide Inpatient Sample. Children (≤ 17 years) who underwent laparoscopic cholecystectomy from 2003 to 2007 were selected. Pediatric surgeons performed 90% or higher of their total cases in children. High-volume surgeons were in the top tertile (n ≥ 37 per year) of total cholecystectomies performed. χ(2), Analyses of variance, and multivariate linear and logistic regression analyses were used to assess in-hospital complications, median length of hospital stay (LOS), and total hospital costs (2007 dollars).
  
  
  RESULTS
  A total of 3596 pediatric cholecystectomies were included. Low-volume surgeons had more complications, longer LOS, and higher costs than high-volume surgeons. After adjustment in multivariate regression, surgeon volume, but not specialty, was an independent predictor of LOS and cost.
  
  
  CONCLUSIONS
  High-volume surgeons have better outcomes after pediatric cholecystectomy than low-volume surgeons. To optimize outcomes in children after cholecystectomy, surgeon volume and laparoscopic experience should be considered above surgeon specialty.
authors.affiliation: Department of Surgery, Yale University School of Medicine, PO Box 208062, New Haven, CT 06520, USA.
authors.forename: Kesi
authors.initials: K
authors.lastname: Chen
authors.forename: Kevin
authors.initials: K
authors.lastname: Cheung
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D005705:Gallbladder Diseases / Q000191:economics / Q000601:surgery*; D013502:General Surgery; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010372:Pediatrics; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States