| Surgeon volume metrics in laparoscopic cholecystectomy. | |
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MedLine Citation:
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PMID: 19911275 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIM: Numerous reports in the 1990s pointed to a learning curve for laparoscopic cholecystectomy (LC), critical in achieving excellent outcomes. As LC is now standard therapy for acute cholecystitis (AC), we aimed to determine if surgeon volume is still vital to patient outcomes. METHODS: The Nationwide Inpatient Sample was used to query 80,149 emergent/urgent cholecystectomies performed for AC from 1999 to 2005 in 12 states with available surgeon/hospital identifiers. Volume groups were determined based on thirds of number of cholecystectomies performed per year for AC; two groups were created [low volume (LV): <or=15/year; high volume (HV): >15/year]. Primary endpoints were the rate of open conversion, bile duct injury (BDI), in-hospital mortality, and prolonged length of stay (LOS). Propensity scores were used to create a matched cohort analysis. Logistic regression models were created to further assess the effect of surgeon volume on primary endpoints. RESULTS: The number of cases performed by HV surgeons increased from 24% to 44% from 1999 to 2005. HV surgeons were more likely to perform LC, had fewer conversions, lower incidence of prolonged LOS, lower BDI, and lower in-hospital mortality. After matching the volume cohorts to create a case-controlled analysis, multivariate analysis confirmed that surgeon volume was an independent predictor of open conversion and prolonged LOS but not BDI and in-hospital mortality. CONCLUSIONS: Increasing surgical volume remains associated with improved outcomes after surgery during emergent/urgent admission for AC with fewer open conversions and prolonged LOS. Our results suggest that referral to HV surgeons has improved outcomes after LC for AC. |
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Authors:
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Nicholas G Csikesz; Anand Singla; Melissa M Murphy; Jennifer F Tseng; Shimul A Shah |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2009-11-13 |
Journal Detail:
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Title: Digestive diseases and sciences Volume: 55 ISSN: 1573-2568 ISO Abbreviation: Dig. Dis. Sci. Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-06-29 Completed Date: 2010-07-20 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7902782 Medline TA: Dig Dis Sci Country: United States |
Other Details:
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Languages: eng Pagination: 2398-405 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, MA 01655, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Cholecystectomy, Laparoscopic
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statistics & numerical data* Cholecystitis, Acute / surgery* Clinical Competence Female Humans Length of Stay Male Middle Aged Multivariate Analysis Physicians / statistics & numerical data* Time Factors Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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