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Comparison of initial laparoscopic cholecystectomy at a community hospital versus a teaching hospital
B Dubois1, A G Nagy, D Anderson
1Department of Surgery, University of British Columbia, Vancouver.
Objective:
To compare the initiation of laparoscopic cholecystectomy at a community hospital versus a tertiary-care teaching hospital.
Design:
Retrospective chart review.
Settings:
A general community hospital in Prince George, BC, and a tertiary-care teaching hospital in Vancouver.
Patients:
One hundred and eighty-two patients in the community hospital and 318 patients in the tertiary-care centre.
Intervention:
Laparoscopic cholecystectomy for symptomatic gallbladder disease.
Main Outcome Measures:
Preparation of surgeons for the new technique, complication rates, operating time, conversion rates to open cholecystectomy and duration of hospitalization.
Results:
All community surgeons took didactic and laboratory courses in preparation for the new procedure and assisted each other for their first 10 cases, but surgeons at the teaching hospital had more varied preparation that included additional extensive laboratory work and preceptorships with surgeons experienced with the procedure. The rates of major complications of laparoscopic cholecystectomy were 6.5% at the community hospital compared with 5% at the tertiary-care centre. The rates of minor complications were 5.5% at community hospital and 5.3% at the tertiary-care centre. The rates of conversion to open cholecystectomy were 6.6% for the community hospital versus 4.7% for teaching hospital. The mean (and standard deviation) operating time was shorter at the community hospital than at the teaching hospital: 72.3 (30) minutes versus 106 (32) minutes (p < 0.0001). The mean (SD) length of stay was 2.5 (1.8) days at the community hospital and 3.4 (1.9) days at the teaching hospital.
Conclusions:
The introduction of laparoscopic cholecystectomy during a 2-year period was achieved safely at both hospitals. The complication rates were similar. The length of stay and operating times were shorter in the community hospital.