Surgeon volume trumps specialty: outcomes from 3596 pediatric cholecystectomies

Laparoscopic cholecystectomy is the standard surgical management of biliary disease in children, but there has been a paucity of studies addressing outcomes after pediatric cholecystectomies, particularly on a national level. We conducted the first study to address the effect of surgeon specialty and volume on clinical and economic outcomes after pediatric cholecystectomies on a population level.

We conducted a retrospective cross-sectional study using the Health Care Utilization Project Nationwide Inpatient Sample. Children (≤ 17 years) who underwent laparoscopic cholecystectomy from 2003 to 2007 were selected. Pediatric surgeons performed 90% or higher of their total cases in children. High-volume surgeons were in the top tertile (n ≥ 37 per year) of total cholecystectomies performed. χ(2), Analyses of variance, and multivariate linear and logistic regression analyses were used to assess in-hospital complications, median length of hospital stay (LOS), and total hospital costs (2007 dollars).

A total of 3596 pediatric cholecystectomies were included. Low-volume surgeons had more complications, longer LOS, and higher costs than high-volume surgeons. After adjustment in multivariate regression, surgeon volume, but not specialty, was an independent predictor of LOS and cost.

High-volume surgeons have better outcomes after pediatric cholecystectomy than low-volume surgeons. To optimize outcomes in children after cholecystectomy, surgeon volume and laparoscopic experience should be considered above surgeon specialty.