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Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
National trends in the utilization of cholecystectomy in children
Eric J Balaguer1, Mitchell R Price, Randall S Burd
1Department of Surgery, Division of Pediatric Surgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903, USA.
Insights
Pediatric cholecystectomy rates increased, especially without risk factors, with laparoscopic surgery becoming standard. Laparoscopic procedures reduced hospital stays but did not alter in-hospital outcomes.
Area of Science:
- Pediatric surgery
- Gastrointestinal surgery
- Surgical trends
Background:
- Cholecystectomy indications in children have evolved over three decades.
- Studies suggest an increasing frequency of this procedure in pediatric populations.
Purpose of the Study:
- To evaluate recent trends in the utilization of cholecystectomy in children.
- To assess changes in the laparoscopic era.
Main Methods:
- Analysis of Nationwide Inpatient Sample data (1996-2003) for children (<15 years) undergoing cholecystectomy.
- Identification of medical conditions and procedures using ICD-9 codes.
- Calculation of population-based rates and statistical analysis.
Main Results:
- An estimated 11,823 pediatric cholecystectomies were performed.
- A significant increase in cholecystectomies was observed in children without hemolytic anemia.
- Laparoscopic approach increased from 77% to 91%, particularly in younger children (<5 years).
- Laparoscopic cholecystectomy was associated with a 2.3-day shorter length of stay without increased complications or mortality.
Conclusions:
- Indications for pediatric cholecystectomy continue to evolve in the laparoscopic era.
- Increased laparoscopic cholecystectomy use correlates with decreased hospital stay but not improved in-hospital outcomes.
- Further research is needed on the impact on operative biliary tract injury and long-term outcomes.
Background:
Previous studies have suggested that indications for cholecystectomy in children have evolved over the past three decades contributing to an increased frequency of this procedure. The purpose of this study was to evaluate recent trends in utilization of cholecystectomy in children in the laparoscopic era.
Materials And Methods:
Children (<15 year) undergoing cholecystectomy between 1996 and 2003 were identified in the Nationwide Inpatient Sample. Underlying medical illness and related biliary tract conditions and procedures were identified using ICD-9 codes. Census data were used to calculate population-based rates stratifying by age and risk factors for cholelithiasis. Univariate and multivariate analyses were performed accounting for survey design.
Results:
During the study period, an estimated 11,823 cholecystectomies were performed nationwide. While the population frequency of children with hemolytic anemia undergoing cholecystectomy did not significantly change, the frequency of children undergoing cholecystectomy without this risk factor increased from 1.5 to 2.5 procedures/100,000 population (P = 0.03). The percentage undergoing cholecystectomy by a laparoscopic approach increased from 77 to 91% (P < 0.001), with the largest increase being observed in children <5 years old (36% versus 90%, P < 0.001). While no significant differences in in-hospital surgical complications or mortality were observed, laparoscopic cholecystectomy was associated with a 2.3 d (P < 0.001) shorter length of stay than open cholecystectomy.
Conclusions:
The indications for cholecystectomy have continued to evolve in the laparoscopic era. While the increased use of laparoscopic cholecystectomy has been associated with decreased length of stay, this approach has not been associated with changes in in-hospital outcomes. The effect of these trends on rates of operative biliary tract injury and long-term outcome require additional study.
