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Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases
Insights
This study found significant variations in emergency cholecystectomy rates among UK and Irish hospitals. Patient factors and hospital characteristics influence emergency gallbladder surgery decisions, leading to inconsistent care.
Area of Science:
- Surgical outcomes
- Health services research
- Gastroenterology
Background:
- Emergency cholecystectomy rates vary significantly between hospitals.
- Patient and hospital factors influence the decision for emergency gallbladder surgery.
- Understanding these variations is crucial for improving care consistency.
Purpose of the Study:
- Identify patient and hospital characteristics associated with emergency cholecystectomy.
- Determine how these factors contribute to inter-hospital variations in emergency surgery.
- Analyze the influences on emergency cholecystectomy performance.
Main Methods:
- Prospective, population-based cohort study.
- Data collected from 4744 cholecystectomies across 165 UK and Irish hospitals (March-May 2014).
- Multilevel, multivariable logistic regression used to analyze patient and hospital factors.
Main Results:
- Factors like increasing age, lower ASA grade, biliary colic, and specific imaging/interventions reduced the likelihood of emergency cholecystectomy.
- Significant variations in predicted probabilities of emergency cholecystectomy were observed across hospitals (0.02 to 0.95).
- A model predicted a mean probability of 0.52 for emergency cholecystectomy in a defined patient group.
Conclusions:
- Patients with similar acute gallbladder pathology receive inequitable care across different hospitals.
- Significant inter-hospital variability exists in the provision of emergency cholecystectomy.
- Standardization of care pathways for acute gallbladder disease is warranted.
Background:
The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.
Methods:
Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).
Results:
Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2 , who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.
Conclusion:
Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.
