Background Since 1989, laparoscopic cholecystectomy has beenwidely adopted as a treatment for gallstone disease. We analyzedthe association between the introduction of this procedure andthree variables: the rate at which cholecystectomy was performedin Maryland, the characteristics of patients undergoing cholecystectomyin routine clinical practice, and operative mortality.
Methods and Results We used 1985-1992 hospital-discharge datafrom all 54 acute care hospitals in Maryland to identify openand laparoscopic cholecystectomies, characteristics of patientsundergoing these procedures, and deaths occurring during hospitalizationsin which these procedures were performed. The annual rate ofcholecystectomy, adjusted for age, rose from 1.69 per 1000 stateresidents in 1987-1989 to 2.17 per 1000 residents in 1992, anincrease of 28 percent (P<0.001). As compared with patientsundergoing open cholecystectomy, patients undergoing laparoscopiccholecystectomy tended to be younger, less likely to have acutecholecystitis or a common-duct stone, and more likely to bewhite and have private health insurance or belong to a healthmaintenance organization (P<0.001). Although the operativemortality associated with laparoscopic cholecystectomy was lessthan that with open cholecystectomy (adjusted odds ratio, 0.22;95 percent confidence interval, 0.13 to 0.37) and the overallmortality rate for all cholecystectomies declined from 0.84percent in 1989 to 0.56 percent in 1992, there was no significantchange in the total number of cholecystectomy-related operativedeaths because of the increase in the cholecystectomy rate.
Conclusions In Maryland, although the adoption of laparoscopiccholecystectomy has been accompanied by a 33 percent decreasein overall operative mortality per procedure, the total numberof cholecystectomy-related deaths has not fallen because ofa 28 percent increase in the total rate of cholecystectomy.
Source Information
From the Departments of Medicine (C.A.S., E.B.B., E.P.S.) and Surgery (M.A.T., H.A.P.), School of Medicine, and the Department of Health Policy and Management (E.B.B., E.P.S.), School of Hygiene and Public Health, Johns Hopkins University, Baltimore.
Address reprint requests to Dr. Steinberg at Johns Hopkins University, Program for Medical Technology and Practice Assessment, 1830 E. Monument St., Rm. 8068, Baltimore, MD 21205.
Inderbitzin, D. Th., Marti, G. R., Eichenberger, S., Hoogewoud, H.- M., Kraehenbuehl, L.
(2008). Enhanced Tumour Growth and Impaired Cellular Antitumoural Defence in Hepatic Colorectal Carcinoma Metastasis in Rats after Laparoscopy Compared to Open Surgery. Ann. Surg. Oncol.
15: 1239-1248
[Abstract][Full Text]
Gray, J A M.
(2006). Redefining Health Care: Creating Value-Based Competition on Results. BMJ
333: 760-760
[Full Text]
Nicholson, W. K., Fox, H. E., Cooper, L. A., Strobino, D., Witter, F., Powe, N. R.
(2006). Maternal Race, Procedures, and Infant Birth Weight in Type 2 and Gestational Diabetes.. Obstet Gynecol
108: 626-634
[Abstract][Full Text]
Novitsky, Y. W., Kercher, K. W., Harrell, A. G., Heniford, B. T.
(2006). Laparoscopic expertise increases hospital volume of adrenal surgery.. SURG INNOV
13: 109-114
[Abstract]
Urbach, D. R., Stukel, T. A.
(2005). Rate of elective cholecystectomy and the incidence of severe gallstone disease. CMAJ
172: 1015-1019
[Abstract][Full Text]
Stahl, J. E., Rattner, D., Wiklund, R., Lester, J., Beinfeld, M., Gazelle, G. S.
(2004). Reorganizing the System of Care Surrounding Laparoscopic Surgery: A Cost-Effectiveness Analysis Using Discrete-Event Simulation. Med Decis Making
24: 461-471
[Abstract]
Cottam, D. R., Mattar, S. G., Schauer, P. R.
(2003). Laparoscopic Era of Operations for Morbid Obesity. Arch Surg
138: 367-375
[Full Text]
Michel, L A, Johnson, P
(2002). Is surgical mystique a myth and double standard the reality?. Med. Humanities
28: 66-70
[Abstract][Full Text]
GARCIA, F. A. R., MILLER, H. B., HUGGINS, G. R., GORDON, T. A.
(2001). Effect of Academic Affiliation and Obstetric Volume on Clinical Outcome and Cost of Childbirth. Obstet Gynecol
97: 567-576
[Abstract][Full Text]
Glasgow, R. E., Cho, M., Hutter, M. M., Mulvihill, S. J.
(2000). The Spectrum and Cost of Complicated Gallstone Disease in California. Arch Surg
135: 1021-1025
[Abstract][Full Text]
Laycock, W. S., Siewers, A. E., Birkmeyer, C. M., Wennberg, D. E., Birkmeyer, J. D.
(2000). Variation in the Use of Laparoscopic Cholecystectomy for Elderly Patients With Acute Cholecystitis. Arch Surg
135: 457-462
[Abstract][Full Text]
O'DONNELL, L J D
(1999). Post-cholecystectomy diarrhoea: a running commentary. Gut
45: 796-797
[Full Text]
Eisenberg, J. M.
(1999). Ten Lessons for Evidence-Based Technology Assessment. JAMA
282: 1865-1869
[Full Text]
Pronovost, P. J., Jenckes, M. W., Dorman, T., Garrett, E., Breslow, M. J., Rosenfeld, B. A., Lipsett, P. A., Bass, E.
(1999). Organizational Characteristics of Intensive Care Units Related to Outcomes of Abdominal Aortic Surgery. JAMA
281: 1310-1317
[Abstract][Full Text]
Chernew, M. E., Hirth, R. A., Sonnad, S. S., Ermann, R., Fendrick, A. M.
(1998). Managed Care, Medical Technology, and Health Care Cost Growth: A Review of the Evidence. Med Care Res Rev
55: 259-288
[Abstract]
Weber, A. M., Lee, J.-C.
(1996). Use of Alternative Techniques of Hysterectomy in Ohio, 1988-1994. NEJM
335: 483-489
[Abstract][Full Text]
Lam, C.-M., Cuschieri, A., Murray, F. E
(1995). Rate of surgery for gall stones is increasing. BMJ
311: 1092-1092
[Full Text]
Zahedi, T., Steiner, C. A., Bass, E. B., Steinberg, E. P.
(1994). Laparoscopic Cholecystectomy. NEJM
331: 54-55
[Full Text]
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