title: Ninety-day postdischarge outcomes of inpatient elective laparoscopic cholecystectomy.
abstract: BACKGROUND
  Little information is available about postdischarge adverse events after laparoscopic cholecystectomy.
  
  
  METHODS
  Inpatient and 90-day postdischarge adverse events were identified for Medicare patients discharged in 2009-2010 after undergoing elective laparoscopic cholecystectomy on day 0, 1, or 2 of hospitalization at facilities that performed 20 or more laparoscopic cholecystectomies during the study period. A predictive length of stay (LOS) linear regression model was derived and used to identify patients with prolonged LOS (prLOS) whose risk-adjusted LOS exceeded a 3σ upper limit on a moving average control chart. Rates of inpatient and 90-day fatal and nonfatal adverse events and interrelationships among different outcomes and alternative outcome measures were explored.
  
  
  RESULTS
  Of 89,639 study cases, 0.7% died during their index hospitalization, and 1.3% died within 90 days of discharge. Of live discharges, 8.0% had prLOS, and 42.1% had coded complication. In the 90 days after discharge, 9,416 (10.6%) were readmitted. Patients who were prLOS outliers were more likely to die or be readmitted than nonoutliers (P < .0001; χ(2)).
  
  
  CONCLUSIONS
  More than 18% of Medicare patients undergoing presumably low-risk elective inpatient laparoscopic cholecystectomy died, had a severe inpatient complication, or were readmitted within 90 days of discharge.
authors.affiliation: Michael Pine and Associates, Chicago, IL; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; University of New Mexico School of Medicine, Albuquerque, NM. Electronic address: dfry@consultmpa.com.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Fry
authors.affiliation: Michael Pine and Associates, Chicago, IL; Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL.
authors.forename: Michael
authors.initials: M
authors.lastname: Pine
authors.affiliation: Michael Pine and Associates, Chicago, IL.
authors.forename: Gregory
authors.initials: G
authors.lastname: Pine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000401:mortality*; D017558:Elective Surgical Procedures / Q000401:mortality*; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D006278:Medicare; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D014481:United States