Nationwide trends in the use of subtotal cholecystectomy for acute cholecystitis.
Adult
Asian
/ statistics & numerical data
Cholecystectomy, Laparoscopic
/ methods
Cholecystitis, Acute
/ surgery
Conversion to Open Surgery
/ statistics & numerical data
Female
Gallbladder
/ surgery
Hospitals, Teaching
/ statistics & numerical data
Humans
Length of Stay
Male
Middle Aged
Patient Preference
/ statistics & numerical data
Practice Patterns, Physicians'
/ statistics & numerical data
Retrospective Studies
Sex Factors
Young Adult
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
27
07
2019
revised:
16
10
2019
accepted:
02
11
2019
pubmed:
28
12
2019
medline:
27
6
2020
entrez:
28
12
2019
Statut:
ppublish
Résumé
Subtotal cholecystectomy is a viable alternative approach to the proverbial "difficult" gallbladder. To date, only a few studies have observed the establishment of those bail-out procedures as an increasingly common surgical practice. The purpose of this study is to assess nationwide trends of subtotal cholecystectomy through evaluation of operative variables and patient- and institution-level characteristics in procedure preference. Data were obtained from the National Inpatient Sample for the years between 2003 and 2014. Patients with acute cholecystitis were categorized based on the ninth revision International Classification of Disease Clinical Modification procedure codes for open total, laparoscopic total, open subtotal, or laparoscopic subtotal cholecystectomy. Any patient younger than 18 years of age or with a preoperative stay >1 week was excluded. Logistic regression analysis was performed to evaluate significant patient- and institution-level characteristics associated with the performance of subtotal cholecystectomy. A total of 290,855 patients were evaluated. During the study period, the rate of open and laparoscopic subtotal cholecystectomy sharply increased (0.10% of all cholecystectomy procedures to 0.52% and 0.12% to 0.28%, respectively). The conversion rate from laparoscopic to open total cholecystectomy decreased from 10.5% to 7.6%. Subtotal cholecystectomies were performed at significantly higher rates in men (odds ratio: 1.95, P < .001), Asian Americans (odds ratio: 2.21, P = .037), and patients with alcohol abuse (odds ratio: 2.23, P < .001). Teaching hospitals (odds ratio: 2.41, P < .001) and those in rural areas (odds ratio: 2.26, P < .001) were more likely to perform subtotal cholecystectomies. Growing trends in the use of subtotal cholecystectomy suggest evolving surgical practices for acute cholecystitis. Our data suggests that several patient- and hospital-level characteristics might play a deciding role in procedure preference.
Sections du résumé
BACKGROUND
Subtotal cholecystectomy is a viable alternative approach to the proverbial "difficult" gallbladder. To date, only a few studies have observed the establishment of those bail-out procedures as an increasingly common surgical practice. The purpose of this study is to assess nationwide trends of subtotal cholecystectomy through evaluation of operative variables and patient- and institution-level characteristics in procedure preference.
METHODS
Data were obtained from the National Inpatient Sample for the years between 2003 and 2014. Patients with acute cholecystitis were categorized based on the ninth revision International Classification of Disease Clinical Modification procedure codes for open total, laparoscopic total, open subtotal, or laparoscopic subtotal cholecystectomy. Any patient younger than 18 years of age or with a preoperative stay >1 week was excluded. Logistic regression analysis was performed to evaluate significant patient- and institution-level characteristics associated with the performance of subtotal cholecystectomy.
RESULTS
A total of 290,855 patients were evaluated. During the study period, the rate of open and laparoscopic subtotal cholecystectomy sharply increased (0.10% of all cholecystectomy procedures to 0.52% and 0.12% to 0.28%, respectively). The conversion rate from laparoscopic to open total cholecystectomy decreased from 10.5% to 7.6%. Subtotal cholecystectomies were performed at significantly higher rates in men (odds ratio: 1.95, P < .001), Asian Americans (odds ratio: 2.21, P = .037), and patients with alcohol abuse (odds ratio: 2.23, P < .001). Teaching hospitals (odds ratio: 2.41, P < .001) and those in rural areas (odds ratio: 2.26, P < .001) were more likely to perform subtotal cholecystectomies.
CONCLUSION
Growing trends in the use of subtotal cholecystectomy suggest evolving surgical practices for acute cholecystitis. Our data suggests that several patient- and hospital-level characteristics might play a deciding role in procedure preference.
Identifiants
pubmed: 31879089
pii: S0039-6060(19)30740-8
doi: 10.1016/j.surg.2019.11.004
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
569-574Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.