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[The Individual Surgeon is an Independent Risk Factor for Morbidity after Cholecystectomy. A Multivariate Analysis of
1Allgemein-, Viszeral- und Minimalinvasive Chirurgie, Klinikum Bad Hersfeld GmbH, Bad Hersfeld, Deutschland.
Background:
In sophisticated surgical procedures, e. g. colectomy, cardiac surgery, arterial reconstruction and liver resection, the individual surgeon is a major influence on postoperative morbidity. For the everyday procedure of cholecystectomy, clear data on the morbidity related to the individual surgeon are lacking.
Aims:
To assess the individual impact on the outcome of cholecystectomy in a cohort of experienced surgeons.
Methods:
The analysis covered n = 710 consecutive patients who had received cholecystecomy between January 2014 and December 2018 - performed by experienced surgeons (> n = 300 cholecystectomies before entry in the study and > 5 years after specialty registration). In a univariate analysis, the influence of patient characteristics, laboratory findings and surgical data on postoperative morbidity were investigated. Variables with statistical significance were entered into a multivariate logistic regression.
Results:
Mortality was 5/710 (0.7%), and morbidity was 58/710 (8.2%), including 37/710 patients with surgical morbidity and 21/710 patients with non-surgical morbidity. In a multivariable analysis the independent risk factors for overall morbidity were creatinine level (OR 1.29, CI 1.01-1.648, p = 0.042), GOT (OR 1.005, CI 1-1.01, p = 0.03), open/conversion surgery (OR 4.134, CI 1.587-10.768, p = 0.004) and the individual surgeon (OR up to 40.675, p = 0.001). In the analysis of surgical complications, open/conversion surgery (OR 8.104, CI 3.03-21.68, p < 0.001) and the individual surgeon (OR up to 79.69, p = 0.005) remained of significant influence.
Conclusions:
The individual surgeon is of major influence on the outcome after an everyday procedure such as cholecystectomy in a group of experienced surgeons with specialty registration. The individual outcome of each surgeon should be measured as a basis of targeted improvement programs.
