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Childhood cholecystectomy in New Zealand: A multicenter national 10year perspective
Sandra Campbell1, Ben Richardson2, Prabal Mishra3
1Waikids Surgical Department, Waikato District Health Board, Hamilton, New Zealand.
Insights
Pediatric cholecystectomy rates in New Zealand remain stable, unlike international trends. Māori children face higher risks for biliary disease and complications, warranting further investigation.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Public Health
Background:
- Cholelithiasis (gallstones) incidence is rising globally in children.
- Pediatric surgeons face an increasing caseload for cholecystectomy (gallbladder removal).
Purpose of the Study:
- To review pediatric cholecystectomies in New Zealand from 2004-2013.
- To examine trends in incidence and patient demographics for pediatric cholecystectomy.
Main Methods:
- Retrieved and analyzed demographic data, diagnoses, comorbidities, length of stay, and complications for patients under 16.
- Excluded patients with congenital biliary malformations.
- Performed statistical analysis using SPSS.
Main Results:
- 170 pediatric cholecystectomies were performed, averaging 15 annually with a slight upward trend.
- The median patient age was 14 years; 31% were overweight or obese.
- Māori children were overrepresented and had a disproportionately higher complication rate (27%).
Conclusions:
- New Zealand has not experienced the rapid rise in pediatric cholecystectomies seen internationally.
- Adolescent biliary disease is a significant issue, particularly among overweight Caucasian children.
- Māori children exhibit a high relative risk for biliary disease and postoperative complications, requiring further study.
Aim:
International studies show increasing incidence of cholelithiasis in childhood and an increasing caseload for the pediatric surgeon. We reviewed pediatric cholecystectomy in all four centers in New Zealand, examining changes in incidence and the demographics of the patient population.
Method:
Coding data were used to retrieve case notes and extract demographic data, diagnosis, comorbidities, length of stay, and complications for patients less than 16years old undergoing cholecystectomy from January 1st, 2004-December 31st, 2013. Patients with congenital biliary malformations were excluded. Statistical analysis was performed using SPSS.
Results:
170 children required cholecystectomy. On average, 15 procedures were performed annually (IQR 8-24). There was a slight upward trend, with a gradient of 0.34 (P=0.63). Median age was 14 (range 2-15)years, male:female 2:3. While 72% of children were Caucasian, Māori were significantly overrepresented (20%). Numbers of Pacific Islander increased significantly over time (P=0.05), in line with population increases. Of 114 patients with complete dataset, 31% were overweight or obese. Complication rates were 8.8% overall, but 27% of complications occurred in Māori children. 40% of those suffering a complication were obese. Three complications were major, requiring return to theater. Mean length of stay was 5days.
Conclusions:
New Zealand has not seen the rapid increase in pediatric cholecystectomy experienced elsewhere in the OECD. However, the problem of adolescent biliary disease is prevalent. The average recipient of a cholecystectomy is 14years old, overweight, and Caucasian; though Māori have a high relative risk of both biliary disease and complicated postoperative course. The reasons for this remain unclear and require further study.
