Establishing benchmarks for the management of elevated liver enzymes and/or dilated biliary trees in an urban safety net hospital: analysis of 915 subjects.
BACKGROUND
The push for public reporting of outcomes necessitates relevant benchmarks for disease states across different settings. This study establishes benchmarks for choledocholithiasis management in a safety net hospital setting.


METHODS
We reviewed all patients admitted to our acute care surgery service with biochemical evidence of choledocholithiasis who underwent same-admission cholecystectomy (CCY) between July 2012 and December 2013.


RESULTS
During this 18-month period, 915 patients were admitted with biochemical evidence of choledocholithiasis. Descriptive statistics for the cohort are provided, which include a 51% rate of obesity and 95% rate of pathologic cholecystitis. Conversion rates of 4% and complication rates of 6% were found. The majority had a CCY without biliary imaging (n = 630, 68.9%).


CONCLUSIONS
Relevant benchmarks are characterized, and results of a practice pattern of omitting pre- or intraoperative biliary tree imaging are described. These findings serve as a first benchmark of choledocholithiasis management for urban safety net hospitals.
Department of Surgery, UT Southwestern Medical Center, Parkland Memorial Hospital, Dallas, TX, USA.
Laindy
L
Liu
Department of Surgery, UT Southwestern Medical Center, Parkland Memorial Hospital, Dallas, TX, USA.
Michael W
MW
Cripps
Department of Surgery, UT Southwestern Medical Center, Parkland Memorial Hospital, Dallas, TX, USA.
Andrew J
AJ
Riggle
Division of Burns/Trauma/Critical Care, Department of Surgery, UT Southwestern Medical Center, Parkland Memorial Hospital, 5323 Harry Hines Blvd., E5.508A, Dallas, TX 75390-9158, USA.
Steven E
SE
Wolf
Division of Biostatistics, Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA.
Paul A
PA
Nakonezny
Division of Burns/Trauma/Critical Care, Department of Surgery, UT Southwestern Medical Center, Parkland Memorial Hospital, 5323 Harry Hines Blvd., E5.508A, Dallas, TX 75390-9158, USA. Electronic address: herb.phelan@utsouthwestern.edu.
Herb A
HA
Phelan
D000328:Adult; D019985:Benchmarking; D001659:Biliary Tract / Q000000981:diagnostic imaging / Q000201:enzymology; D017081:Cholecystectomy, Laparoscopic; D042883:Choledocholithiasis / Q000000981:diagnostic imaging / Q000201:enzymology / Q000601:surgery*; D004108:Dilatation, Pathologic; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D064876:Safety-net Providers; D016896:Treatment Outcome; D014463:Ultrasonography
Benchmarking; Choledocholithiasis; Laparoscopic cholecystectomy; Outcome reporting; Safety net hospital