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Surgeon volume metrics in laparoscopic cholecystectomy
Nicholas G Csikesz1, Anand Singla, Melissa M Murphy
1Department of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, MA 01655, USA.
Digestive Diseases and Sciences
|November 14, 2009
Summary
High-volume surgeons performing laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) achieve better outcomes. Increased surgeon volume is linked to fewer open conversions and shorter hospital stays, emphasizing the importance of surgeon expertise.
Area of Science:
- Surgical Outcomes Research
- Gastrointestinal Surgery
- Health Services Research
Background:
- Laparoscopic cholecystectomy (LC) is the standard treatment for acute cholecystitis (AC).
- Previous studies highlighted a learning curve for LC, suggesting surgeon experience is crucial for optimal results.
- The continued impact of surgeon volume on AC outcomes in current practice remains an area of investigation.
Purpose of the Study:
- To evaluate the association between surgeon volume and patient outcomes for emergent/urgent laparoscopic cholecystectomy (LC) in acute cholecystitis (AC).
- To determine if surgeon volume remains a significant predictor of key surgical outcomes.
- To inform clinical practice regarding patient referral for AC surgery.
Main Methods:
- Analysis of 80,149 emergent/urgent cholecystectomies for AC from 1999-2005 using the Nationwide Inpatient Sample.
- Surgeons categorized into low-volume (LV; <=15/year) and high-volume (HV; >15/year) groups.
- Primary outcomes included open conversion rates, bile duct injury (BDI), in-hospital mortality, and prolonged length of stay (LOS).
- Propensity score matching and logistic regression used to analyze the impact of surgeon volume.
Main Results:
- High-volume (HV) surgeons performed a greater proportion of LC cases over time (24% to 44%).
- HV surgeons demonstrated lower rates of open conversion, prolonged LOS, BDI, and in-hospital mortality compared to LV surgeons.
- Multivariate analysis confirmed surgeon volume as an independent predictor for reduced open conversion and prolonged LOS, but not for BDI or mortality.
Conclusions:
- Increasing surgeon volume in laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) is associated with improved patient outcomes.
- Specifically, higher surgical volume correlates with fewer open conversions and shorter hospital stays.
- These findings support the referral of patients with AC to high-volume surgeons for improved surgical results.