Epidemiological study of provision of cholecystectomy in England from 2000 to 2009: retrospective analysis of Hospital Episode Statistics

• Published in: Surgical endoscopy Vol. 27; no. 1; pp. 162 - 175
• Main Authors: Sinha, Sidhartha, Hofman, David, Stoker, David L., Friend, Peter J., Poloniecki, Jan D., Thompson, Matt M., Holt, Peter J. E.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 2013; Springer Nature B.V
• Subjects: Abdominal Surgery; Age Distribution; Analysis of Variance; Bile ducts; Cholecystectomy; Cholecystectomy - mortality; Cholecystectomy - statistics & numerical data; Cholecystectomy - trends; Comorbidity; Conversion to Open Surgery - mortality; Conversion to Open Surgery - statistics & numerical data; Disease; Emergency Treatment - mortality; Emergency Treatment - statistics & numerical data; England - epidemiology; Female; Gallstones; Gallstones - mortality; Gallstones - surgery; Gastroenterology; Gynecology; Health Facility Size - statistics & numerical data; Hepatology; Hospitals; Hospitals, Special - statistics & numerical data; Humans; International Classification of Diseases; Laparoscopy; Learning curves; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Patients; Proctology; Retrospective Studies; Socioeconomic Factors; Surgery; Surgical outcomes; Treatment Outcome; Trends; England; United Kingdom > UK; Postoperative mortality; Administrative data; Postoperative morbidity; Laparoscopic cholecystectomy; Bile duct injury; Health services research
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-012-2415-0

Background The aim of this study was to report the trends in provision of cholecystectomy in the National Health System in England over the 9 year period from 2000 to 2009 and to determine the major risk factors associated with subsequent poor outcome. Methods The Hospital Episode Statistics database was interrogated to identify all cholecystectomy procedures for biliary stone disease in adult patients (>16 years). Multivariate regression analyses were used to identify independent predictors of in-patient death, 1 year death, conversion to open, major bile duct injury (BDI) requiring operative repair, and length of stay. Results A total of 418,214 cholecystectomy procedures for biliary stone disease were identified. Laparoscopic surgery was used in 348,311 (83.3 %) cases and increased by 14.6 % over the study period. The in-patient mortality rate (0.2 %), 1 year mortality rate (1 %), proportion of cases converted to open (5.0 %), major BDI rate (0.4 %), and mean length of stay (3 days) all decreased over the study period. 52,242 (12.5 %) cases were carried out during an emergency admission and uptake has remained stable over the decade. Emergency surgery was more likely to be performed at high-volume centres (odds ratio [OR] 1.39, 95 % confidence interval [CI] 1.35–1.44) and specialist units (OR 1.32, 95 % CI 1.30–1.35). High-volume centres were more likely to complete emergency cases laparoscopically (OR 1.11, 95 % CI 1.05–1.18). Multivariate regression analysis demonstrated that patient- (male gender, increasing age, and comorbidity) and disease-specific (inflammatory pathology and emergency admission) factors rather than hospital institutional characteristics (annual cholecystectomy volume and presence of specialist surgical units) were associated with poorer outcomes. Conclusions The provision of laparoscopic cholecystectomy in England has increased. This has been associated with improvements in outcomes such as mortality and length of stay. However, emergency cholecystectomy uptake remains sub-optimal and is more likely to be performed at high-volume or specialist hospitals without adverse outcomes. Further research into the routine provision of emergency cholecystectomy in England is needed in order to optimize patient outcomes.