Contemporary Outcomes of Cholecystectomy.

Area of Science:

• Surgical Outcomes Research
• Health Services Research
• Minimally Invasive Surgery

Background:

• Cholecystectomy is a common procedure in the US.
• Increasing patient complexity and evolving surgical techniques necessitate updated analysis of complication rates.
• Contemporary trends in cholecystectomy outcomes remain understudied.

Purpose of the Study:

• To evaluate changes in postoperative outcomes and complication rates.
• Focus on minimally invasive cholecystectomy (laparoscopic or robotic) among Medicare beneficiaries.
• Analysis period: 2011 to 2021.

Main Methods:

• Retrospective cohort study using Medicare fee-for-service claims data (2011-2021).
• Identified beneficiaries undergoing inpatient minimally invasive cholecystectomy.
• Risk-adjusted outcomes (length of stay, readmission, complications, mortality) estimated using multivariable regression.

Main Results:

• Over 516,000 beneficiaries analyzed; unplanned admissions and comorbidity burden increased.
• Risk-adjusted overall complications decreased from 21.5% to 16.5%; serious complications declined from 12.3% to 7.0%.
• Significant reductions observed in intraoperative hemorrhage, blood transfusion, and bile duct injury; postoperative percutaneous drainage rates increased.

Conclusions:

• Surgical complication rates, including bile duct injury, substantially declined from 2011-2021 despite increased patient complexity.
• Improvements may reflect enhanced surgical techniques, overcoming learning curves, or quality improvement initiatives.
• Increased drainage use may indicate evolving practice rather than declining quality, necessitating continued surveillance.