A study was undertaken of Medicare claims coded for cholecystectomy and those coded for laparoscopic cholecystectomy for the four year period 1990–1993 in New York State. During this time period there was a 28.12% increase in total cholecystectomies performed and an increase in the proportion of laparoscopic cholecystectomies from 15.86% to 50.0%. The increase in total cholecystectomies appears to be driven by a dramatic increase in laparoscopic procedures. Possible reasons for this increase include the performance of laparoscopy on patients previously assessed as too risky to undergo the conventional procedure, laparoscopy on mildly symptomatic patients who had previously put off a perceived higher risk open procedure and a possible broadening of indications for gallbladder surgery.
The dramatic increase in the numbers of cholecystectomies performed in the early 1990s may be due in part to procedures performed on a large pool of procrastinating mildly symptomatic patients. If this is the case, then these increased rates should decline to baseline levels as soon as this pool of patients is exhausted. However, if surgeons are performing laparoscopy on asymptomatic patients with gallstones, then these rates may well be sustained. Such a broadening of indications for gallbladder surgery is of concern to many and has prompted the issuance of guidelines concerning the treatment of gallstones. Any broadening of indications for gallbladder surgery also has significant implications for health care costs and the use of health care resources.
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Legorreta AP, Silber JH, Costantino GN, et al: Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy.JAMA, 270:1429–1432, 1993.
Chung RS, Broughan TA: The phenomenal growth of laparoscopic cholecystectomy: a review.Cleveland Clinic J Med, 59:186–191, 1992.
NIH Consensus Statement on Gallstones and Laparoscopic Cholecystectomy, Bethesda, MD, National Institutes of Health, 1993.
Dubois F, Icard P, Berthelot G, et al: Coelioscopic cholecystectomy: preliminary report of 36 cases,Ann Surg, 211:60–62, 1990.
The Southern Surgeons Club: A prospective analyses of 1,518 laparoscopic cholecystectomies.N Engl J Med, 324:1073–1078, 1991.
Pickleman J, Gonzalez RP: The improving results of cholecystectomy.Arch Surg, 121:930–934, 1991.
Nenner RP, Imperato PJ, Alcorn CN: Serious complications of laparoscopic cholecystectomy in New York State.NY State J Med, 92:179–181, 1992.
Nenner RP, Imperato PJ, Alcorn CN: Complications of laparoscopic cholecystectomy in a geriatric population group.NY State J Med 92:518–520, 1992.
Nenner RP, Imperato PJ, Will TO, Starr H, Soroff H: Hospital reported complications of laparoscopic cholecystectomy among Medicare and Medicaid patients.J Community Health 18: 253–260, 1993.
Nenner RP, Imperato PJ, Will TO: Questions patients should ask about laparoscopic cholecystectomy.Ann Int Med 120:143, 1994.
Nenner RP, Imperato PJ: The learning curve.JAMA 271:824, 1994.
Diehl AK: Laparoscopic cholecystectomy. Too much of a good thing?JAMA, 270:1469, 1994.
American College of Physicians. Guidelines for the treatment of gallstones.Ann Int Med 119: 620–622, 1993.
Ransohoff DF, Gracie WA: Treatment of gallstones.Ann Int Med 119:606–619 1993.
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Nenner, R.P., Imperato, P.J., Rosenberg, C. et al. Increased cholecystectomy rates among medicare patients after the introduction of laparoscopic cholecystectomy. J Community Health 19, 409–415 (1994). https://doi.org/10.1007/BF02260323
- Health Care
- Open Procedure
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