We have located links that may give you full text access.
JOURNAL ARTICLE
RESEARCH SUPPORT, NON-U.S. GOV'T
Surgeon volume metrics in laparoscopic cholecystectomy.
Digestive Diseases and Sciences 2010 August
AIM: Numerous reports in the 1990s pointed to a learning curve for laparoscopic cholecystectomy (LC), critical in achieving excellent outcomes. As LC is now standard therapy for acute cholecystitis (AC), we aimed to determine if surgeon volume is still vital to patient outcomes.
METHODS: The Nationwide Inpatient Sample was used to query 80,149 emergent/urgent cholecystectomies performed for AC from 1999 to 2005 in 12 states with available surgeon/hospital identifiers. Volume groups were determined based on thirds of number of cholecystectomies performed per year for AC; two groups were created [low volume (LV): <or=15/year; high volume (HV): >15/year]. Primary endpoints were the rate of open conversion, bile duct injury (BDI), in-hospital mortality, and prolonged length of stay (LOS). Propensity scores were used to create a matched cohort analysis. Logistic regression models were created to further assess the effect of surgeon volume on primary endpoints.
RESULTS: The number of cases performed by HV surgeons increased from 24% to 44% from 1999 to 2005. HV surgeons were more likely to perform LC, had fewer conversions, lower incidence of prolonged LOS, lower BDI, and lower in-hospital mortality. After matching the volume cohorts to create a case-controlled analysis, multivariate analysis confirmed that surgeon volume was an independent predictor of open conversion and prolonged LOS but not BDI and in-hospital mortality.
CONCLUSIONS: Increasing surgical volume remains associated with improved outcomes after surgery during emergent/urgent admission for AC with fewer open conversions and prolonged LOS. Our results suggest that referral to HV surgeons has improved outcomes after LC for AC.
METHODS: The Nationwide Inpatient Sample was used to query 80,149 emergent/urgent cholecystectomies performed for AC from 1999 to 2005 in 12 states with available surgeon/hospital identifiers. Volume groups were determined based on thirds of number of cholecystectomies performed per year for AC; two groups were created [low volume (LV): <or=15/year; high volume (HV): >15/year]. Primary endpoints were the rate of open conversion, bile duct injury (BDI), in-hospital mortality, and prolonged length of stay (LOS). Propensity scores were used to create a matched cohort analysis. Logistic regression models were created to further assess the effect of surgeon volume on primary endpoints.
RESULTS: The number of cases performed by HV surgeons increased from 24% to 44% from 1999 to 2005. HV surgeons were more likely to perform LC, had fewer conversions, lower incidence of prolonged LOS, lower BDI, and lower in-hospital mortality. After matching the volume cohorts to create a case-controlled analysis, multivariate analysis confirmed that surgeon volume was an independent predictor of open conversion and prolonged LOS but not BDI and in-hospital mortality.
CONCLUSIONS: Increasing surgical volume remains associated with improved outcomes after surgery during emergent/urgent admission for AC with fewer open conversions and prolonged LOS. Our results suggest that referral to HV surgeons has improved outcomes after LC for AC.
Full text links
Related Resources
Trending Papers
Heart failure with preserved ejection fraction: diagnosis, risk assessment, and treatment.Clinical Research in Cardiology : Official Journal of the German Cardiac Society 2024 April 12
Proximal versus distal diuretics in congestive heart failure.Nephrology, Dialysis, Transplantation 2024 Februrary 30
Efficacy and safety of pharmacotherapy in chronic insomnia: A review of clinical guidelines and case reports.Mental Health Clinician 2023 October
World Health Organization and International Consensus Classification of eosinophilic disorders: 2024 update on diagnosis, risk stratification, and management.American Journal of Hematology 2024 March 30
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app