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Published on: September 13, 2022
Disparities in outpatient rural cholecystectomy outcomes
Erin C Howell1, Rie Sakai-Bizmark2, Krystal Karunungan3
1Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, 90502, USA; Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM, 87106, USA.
Background:
Previous studies showed comparable outcomes for common in-patient general surgery operations, but it is unknown if this extends to outpatient operations. Our aim was to compare outpatient cholecystectomy outcomes between rural and urban hospitals.
Methods:
A retrospective cohort analysis was done using the Nationwide Ambulatory Surgery Sample for patients 20-years-and-older undergoing cholecystectomy between 2016 and 2018 at rural and urban hospitals. Survey-weighted multivariable regression analysis was performed with primary outcomes including use-of-laparoscopy, complications, and patient discharge disposition.
Results:
The most common indication for operation was cholecystitis in both hospital settings. On multivariable analysis, rural hospitals were associated with higher transfers to short-term hospitals (adjusted odds ratio [aOR] 2.40, 95%CI 1.61-3.58, p < 0.01) and complications (aOR 1.39, 95%CI 1.11-1.75, p < 0.01). No difference was detected with laparoscopy (aOR 1.93, 95%CI 0.73-5.13, p = 0.19), routine discharge (aOR 1.50, 95%C I0.91-2.45, p = 0.11), or mortality (aOR 3.23, 95%CI 0.10-100.0, p = 0.51).
Conclusions:
Patients cared for at rural hospitals were more likely to be transferred to short-term hospitals and have higher complications. No differences were detected in laparoscopy, routine discharge or mortality.
