Recent trends in cholecystectomy in US veterans

Area of Science:

• Surgical Outcomes Research
• Minimally Invasive Surgery Trends
• Veterans Health Administration Healthcare

Background:

• Cholecystectomy is a common surgical procedure for gallbladder disease.
• The adoption of laparoscopic cholecystectomy (LC) has transformed surgical practice.
• Understanding trends and outcomes in specific patient populations, like US Veterans, is crucial for quality improvement.

Purpose of the Study:

• To evaluate the trends in laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) among US Veterans.
• To compare the postoperative outcomes, including mortality and morbidity, between LC and OC.
• To assess changes in outcomes over time for both surgical approaches.

Main Methods:

• Retrospective analysis of 40,722 cholecystectomies performed between 2008 and 2015 in the Veterans Affairs Surgical Quality Improvement Program database.
• Data included patient demographics, surgical approach (LC vs. OC), and postoperative outcomes.
• Cochran-Armitage trend analysis was used to assess changes in outcomes over the study period.

Main Results:

• Laparoscopic cholecystectomy (LC) was performed in 86.4% of cases, with significant improvements in mortality and morbidity over the study period.
• Open cholecystectomy (OC) was associated with higher rates of mortality, morbidity (pneumonia, DVT, surgical site infections), and longer hospital stays.
• While LC outcomes improved, OC showed no significant improvement in mortality and only minimal improvement in morbidity.

Conclusions:

• Laparoscopic cholecystectomy (LC) is the predominant approach in US Veterans and demonstrates significant outcome improvements.
• Open cholecystectomy (OC) in this population carries higher risks, highlighting the need for strategies to minimize its use and improve its results.
• Further efforts are required to enhance postoperative outcomes for patients undergoing open cholecystectomy.