Abstract
Background: With the advent of laparoscopic cholecystectomy patient outcomes and choice of procedure
(laparoscopic vs open) are of vital interest. The purpose of this study was to examine
the mortality and complication rates for patients undergoing laparoscopic and open
cholecystectomy in New York State and to test for differences among hospital peer
groups and regions of the state in the tendency to use the laparoscopic approach.
Methods: A population-based, retrospective cohort study of laparoscopic and open cholecystectomy
was conducted in which data were analyzed on all 30,968 patients who underwent cholecystectomy
as a principal procedure in New York State in 1996. Results: A total of 78.7% of the 30,968 patients who underwent cholecystectomy as a principal
procedure in New York State in 1996 underwent laparoscopic cholecystectomy. The mortality
rate was lower for laparoscopic cholecystectomy than for the open procedure (0.23%
vs 1.90%, P < .0001) and remained significantly lower after patient characteristics related to
patient survival (odds ratio 0.34, P < .0001) were controlled for. The prevalence rate of the 8 most common complications
among cholecystectomy patients was also much lower among patients undergoing laparoscopic
cholecystectomy. Patients undergoing cholecystectomy in public hospitals, Bronx County,
and Kings County were found to be significantly less likely to have laparoscopic procedures,
and patients undergoing cholecystectomy on Long Island were found to be significantly
more likely to have laparoscopic procedures than were other patients in the state.
Conclusions: There are reasonably large differences among hospitals, hospital groups, and regions
of the state in the type of cholecystectomy used, even after adjustment for differences
in patient comorbidities and indications for type of procedure. (Surgery 1999;125:223-31.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Mortality and complications associated with laparoscopic cholecystectomy.Ann Surg. 1996; 224: 609-620
- The outcomes of elective and open cholecystectomies.J Am Coll Surg. 1995; 180: 136-145
- Laparoscopic cholecystectomy: the new gold standard?.Arch Surg. 1992; 127: 917-923
- Surgical rates and operative mortality for open and laparoscopic cholecystectomy in Maryland.N Engl J Med. 1994; 330: 403-408
- Laparoscopic versus minilaparotomy cholecystectomy: a randomised trial.Lancet. 1994; 343: 135-138
- Multivariate comparison of complications after laparoscopic cholecystectomy and open cholecystectomy.Ann Surg. 1995; 221: 381-386
- Clinical and financial aspects of cholecystectomy: laparoscopic vs. open technique.World J Surg. 1997; 21: 91-97
- Serious complications of laparoscopic cholecystectomy in New York State.N Y State J Med. 1992; 92: 179-181
- A prospective analysis of 1518 laparoscopic cholecystectomies.N Engl J Med. 1991; 324: 1073-1078
- Laparoscopic cholecystectomy: early Mayo experience.Mayo Clin Proc. 1992; 67: 449-455
- Minimizing the risk of bile duct injury at laparoscopic cholecystectomy.World J Surg. 1994; 18: 422-426
- Bile duct injury in laparoscopic cholecystectomy.Surg Laparosc Endosc. 1992; 2: 1-7
- Am J Surg. 1993; 165: 390-398
- Laparoscopic cholecystectomy: a statewide experience.Arch Surg. 1993; 128: 494-499
- Laparoscopic cholecystectomy.Lancet. 1991; 338: 801-803
- Laparoscopic laser cholecystectomy: a comparison with mini-lap cholecystectomy.Surg Endosc. 1989; 3: 131-133
- Laparoscopic cholecystectomy: some advantages or just an artifice of new technology?.HPB Surg. 1991; 3: 291-295
- Complications of laparoscopic cholecystectomy in a geriatric population group.N Y State J Med. 1992; 92: 518-520
- The learning curve.JAMA. 1994; 271: 824
- Questions patients should ask about laparoscopic cholecystectomy.Ann Internal Med. 1994; 120: 443
- Multivariate comparison of complications after laparoscopic cholecystectomy and open cholecystectomy.Ann Surg. 1995; 221: 381-386
- Clinical and financial aspects of cholecystectomy laparoscopic versus open technique.World J Surg. 1997; 21: 91-97
Article info
Publication history
Accepted:
September 27,
1998
Footnotes
☆Sponsored by Health Care Financing Administration, Department of Health and Human Services, contract No. 500-P700.
☆☆The content of this publication does not necessarily reflect the views of the Department of Health and Human Services.
★Reprint requests: Pascal James Imperato, MD, IPRO, 1979 Marcus Ave, Lake Success, NY 11042.
Identification
Copyright
© 1999 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
