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Growing use of laparoscopic cholecystectomy in the national Veterans Affairs Surgical Risk Study: effects on volume, patient selection, and selected outcomes.

Publication ,  Journal Article
Chen, AY; Daley, J; Pappas, TN; Henderson, WG; Khuri, SF
Published in: Ann Surg
January 1998

OBJECTIVE: To study the introduction of laparoscopic cholecystectomy to the 43 tertiary-care university-affiliated Veterans Administration medical centers (VAMCs) participating in the National Veterans Affairs Surgical Risk Study from October 1991 through December 1993. SUMMARY BACKGROUND DATA: Previous studies in the private sector have documented growth in the number of cholecystectomies and falling clinical thresholds for cholecystectomy with the introduction of laparoscopic cholecystectomy. METHODS: The following were analyzed for changes over time: measures of patient preoperative risk, complexity of surgery, severity of biliary disease, numbers of procedures, postoperative length of stay, and 30-day postoperative mortality and general complication rates. RESULTS: The number of cholecystectomies performed laparoscopically increased, but the total number of cholecystectomies performed remained stable over time. The proportion of patients with acute cholecystitis, emergent cholecystectomies, and technically complex cholecystectomies did not change or increased slightly over time. Adjusted odds for postoperative general complications were lower for laparoscopic than for open cholecystectomy, but 30-day postoperative mortality and general complication rates for all cholecystectomies remained constant over time. Postoperative length of stay for all cholecystectomies fell significantly. Implementation rates of laparoscopic cholecystectomy varied widely between hospitals. Laparoscopic cholecystectomy was adopted more slowly and used in a lower percentage of cholecystectomies than in non-VA settings. CONCLUSIONS: In contrast to non-VA studies showing increases in overall cholecystectomy volume since the introduction of laparoscopic cholecystectomy, these VAMCs implemented laparoscopic cholecystectomy without growth in cholecystectomies or a change in the clinical threshold for cholecystectomy. Laparoscopic cholecystectomy was associated with better outcomes, but its introduction in the setting of stable cholecystectomy volume and biliary disease case mix did not change postoperative mortality and complication rates. The stable cholecystectomy volume and biliary disease case mix, slower adoption, and lower use of laparoscopic cholecystectomy contrast with previous reports and may result from differences in patients and organization and financing of VA versus non-VA settings.

Duke Scholars

Published In

Ann Surg

DOI

ISSN

0003-4932

Publication Date

January 1998

Volume

227

Issue

1

Start / End Page

12 / 24

Location

United States

Related Subject Headings

  • United States Department of Veterans Affairs
  • United States
  • Treatment Outcome
  • Surgery
  • Risk Factors
  • Prospective Studies
  • Patient Selection
  • Odds Ratio
  • Middle Aged
  • Male
 

Citation

APA
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ICMJE
MLA
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Chen, A. Y., Daley, J., Pappas, T. N., Henderson, W. G., & Khuri, S. F. (1998). Growing use of laparoscopic cholecystectomy in the national Veterans Affairs Surgical Risk Study: effects on volume, patient selection, and selected outcomes. Ann Surg, 227(1), 12–24. https://doi.org/10.1097/00000658-199801000-00003
Chen, A. Y., J. Daley, T. N. Pappas, W. G. Henderson, and S. F. Khuri. “Growing use of laparoscopic cholecystectomy in the national Veterans Affairs Surgical Risk Study: effects on volume, patient selection, and selected outcomes.Ann Surg 227, no. 1 (January 1998): 12–24. https://doi.org/10.1097/00000658-199801000-00003.
Chen, A. Y., et al. “Growing use of laparoscopic cholecystectomy in the national Veterans Affairs Surgical Risk Study: effects on volume, patient selection, and selected outcomes.Ann Surg, vol. 227, no. 1, Jan. 1998, pp. 12–24. Pubmed, doi:10.1097/00000658-199801000-00003.

Published In

Ann Surg

DOI

ISSN

0003-4932

Publication Date

January 1998

Volume

227

Issue

1

Start / End Page

12 / 24

Location

United States

Related Subject Headings

  • United States Department of Veterans Affairs
  • United States
  • Treatment Outcome
  • Surgery
  • Risk Factors
  • Prospective Studies
  • Patient Selection
  • Odds Ratio
  • Middle Aged
  • Male