title: Childhood cholecystectomy in New Zealand: A multicenter national 10year perspective.
abstract: OBJECTIVE
  International studies show increasing incidence of cholelithiasis in childhood and an increasing caseload for the pediatric surgeon. We reviewed pediatric cholecystectomy in all four centers in New Zealand, examining changes in incidence and the demographics of the patient population.
  
  
  METHODS
  Coding data were used to retrieve case notes and extract demographic data, diagnosis, comorbidities, length of stay, and complications for patients less than 16years old undergoing cholecystectomy from January 1st, 2004-December 31st, 2013. Patients with congenital biliary malformations were excluded. Statistical analysis was performed using SPSS.
  
  
  RESULTS
  170 children required cholecystectomy. On average, 15 procedures were performed annually (IQR 8-24). There was a slight upward trend, with a gradient of 0.34 (P=0.63). Median age was 14 (range 2-15)years, male:female 2:3. While 72% of children were Caucasian, Māori were significantly overrepresented (20%). Numbers of Pacific Islander increased significantly over time (P=0.05), in line with population increases. Of 114 patients with complete dataset, 31% were overweight or obese. Complication rates were 8.8% overall, but 27% of complications occurred in Māori children. 40% of those suffering a complication were obese. Three complications were major, requiring return to theater. Mean length of stay was 5days.
  
  
  CONCLUSIONS
  New Zealand has not seen the rapid increase in pediatric cholecystectomy experienced elsewhere in the OECD. However, the problem of adolescent biliary disease is prevalent. The average recipient of a cholecystectomy is 14years old, overweight, and Caucasian; though Māori have a high relative risk of both biliary disease and complicated postoperative course. The reasons for this remain unclear and require further study.
authors.affiliation: Waikids Surgical Department, Waikato District Health Board, Hamilton, New Zealand. Electronic address: Sandra.campbell@waikatodhb.health.nz.
authors.forename: Sandra
authors.initials: S
authors.lastname: Campbell
authors.affiliation: Christchurch Department of Paediatric Surgery, Canterbury District Health Board, Christchurch, New Zealand.
authors.forename: Ben
authors.initials: B
authors.lastname: Richardson
authors.affiliation: Wellington Children's Surgical Department, Capital and Coast District Health Board, Wellington, New Zealand.
authors.forename: Prabal
authors.initials: P
authors.lastname: Mishra
authors.affiliation: Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Wong
authors.affiliation: Waikids Surgical Department, Waikato District Health Board, Hamilton, New Zealand.
authors.forename: Udaya
authors.initials: U
authors.lastname: Samarakkody
authors.affiliation: Christchurch Department of Paediatric Surgery, Canterbury District Health Board, Christchurch, New Zealand.
authors.forename: Spencer
authors.initials: S
authors.lastname: Beasley
authors.affiliation: Wellington Children's Surgical Department, Capital and Coast District Health Board, Wellington, New Zealand.
authors.forename: Kevin
authors.initials: K
authors.lastname: Pringle
authors.affiliation: Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.
authors.forename: Philip
authors.initials: P
authors.lastname: Morreau
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002763:Cholecystectomy / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D002769:Cholelithiasis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Cholecystectomy; Gallstones; New Zealand; Obesity; Risk factors