World Journal of Surgery

, Volume 29, Issue 4, pp 429–436 | Cite as

Profiling Hospital Performance of Laparoscopic Cholecystectomy Based on the Administrative Data of Four Teaching Hospitals in Japan

  • Masahiro Hirose
  • Yuichi ImanakaEmail author
  • Tatsuro Ishizaki
  • Miho Sekimoto
  • Yoshiaki Harada
  • Kazuaki Kuwabara
  • Kenshi Hayashida
  • Eun-Hwan Oh
  • S. Edward Evans
Original Scientific Report


Over the last decade in Japan, laparoscopic cholecystectomy (LC) has replaced traditional open cholecystectomy as the standard of elective surgery for cholelithiasis. The laparoscopic approach has a clinical course relatively easier to standardize among the different types of intraabdominal surgery. However, significant practice variation is suspected in Japan, but there has been little demonstration or discussion based on empirical data. Through the analysis of 1589 elective LC cases from four leading teaching hospitals in Japan between 1996 and 2000, this study aims to demonstrate the surgical variations and to investigate their determinants regarding the length of hospital stay and the health care charge. Substantially and significantly large variation existed among the hospitals in terms of the length of hospital stay and the total health care charge, even after the differences in patient factors were adjusted. Particularly, the combined drug and exam charge per day was strikingly different among the four hospitals, which indicated that the daily process also varied widely, as did the total course of inpatient care. In addition, intra-hospital variation was also remained very large even after adjusting for all the potential correlates studied. This study alarmingly points out great room for improvement in the efficiency of health care resource use and potentially in the quality of care through standardization of LC. It has serious implications for the national policy and individual providers under the on-going health care reforms directed toward higher efficiency and quality.


Laparoscopic Cholecystectomy Cholelithiasis Open Cholecystectomy Hospital Factor Laparoscopic Cholecystectomy Procedure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors are grateful to the participants of the Voluntary Hospitals of Japan Quality Indicator Project for their cooperation with this study: Teine Keijinkai Hospital (Sapporo, Hokkaido), Nikko Memorial Hospital (Muroran, Hokkaido), Takeda General Hospital (Aizu Wakamatsu, Fukushima), Tachikawa General Hospital (Nagaoka, Niigata), Kameda General Hospital (Kamogawa, Chiba), Kawakita General Hospital (Suginami, Tokyo), Keiju General Hospital (Nanao, Ishikawa), Rakuwakai Otowa Hospital (Kyoto, Kyoto), Hosoki Hospital (Kochi, Kochi), and Iizuka Hospital (Iizuka, Fukuoka).

The study was supported in part by Grant-in-Aid for Scientific Research (A)(2) from the Japan Society for the Promotion of Science (No. 16209019) and Health and Labour Sciences Research Grants for Research on Policy Planning and Evaluation from the Ministry of Health Labour and Welfare (H16-Seisaku-014).


  1. 1.
    Cuschieri, A, Dubois, F, Mouiel, J,  et al. 1991The European experience with laparoscopic cholecystectomyAm. J. Surg.161385387CrossRefPubMedGoogle Scholar
  2. 2.
    Muhe, E 1986Die erste Cholecystektomie durch das Laparoskop, Langenbeck’s ArchKlin. Chir.369804Google Scholar
  3. 3.
    Kano, N, Yamakawa, T, Ishikawa, Y,  et al. 1994Laparoscopic cholecystectomy: a report of 409 consecutive cases and its future outlookSurg. Today24399402CrossRefPubMedGoogle Scholar
  4. 4.
    Rosen, MJ, Malm, JA, Tarnoff, M,  et al. 2001Cost-effectiveness of ambulatory laparoscopic cholecystectomySurg. Laparosc. Endosc. Percutan. Tech.11182184CrossRefPubMedGoogle Scholar
  5. 5.
    Kitano, S, Matsumoto, T, Aramaki, M,  et al. 2002Laparoscopic cholecystectomy for acute cholecystitisJ. Hepatobiliary Pancreat. Surg.9534537CrossRefPubMedGoogle Scholar
  6. 6.
    Bosch, F, Wehrman, U, Saeger, HD,  et al. 2002Laparoscopic or open conventional cholecystectomy: clinical and economic considerationsEur. J. Surg.168270277CrossRefPubMedGoogle Scholar
  7. 7.
    McPherson, K, Wennberg, JE, Hovind, OB,  et al. 1982Small-area variations in the use of common surgical procedures: an international comparison of New England, England, and NorwayN. Engl. J. Med.30713101314PubMedGoogle Scholar
  8. 8.
    Perrin, JM, Homer, CJ, Berwick, DM,  et al. 1989Variations in rates of hospitalization of children in three urban communitiesN. Engl. J. Med.32011831187PubMedGoogle Scholar
  9. 9.
    American Society of Anesthesiologists. ASA Physical Status Classification System. Available from:
  10. 10.
    Charlson, ME, Pompei, P, Ales, KL,  et al. 1987A new method of classifying prognostic comorbidity in longitudinal studies: development and validationJ. Chronic Dis.40373383CrossRefPubMedGoogle Scholar
  11. 11.
    Deyo, RA, Cherkin, DC, Ciol, MA 1992Adapting a clinical comorobidity index for use with ICD-9-CM administrative databasesJ. Clin. Epidemiol.45613619CrossRefPubMedGoogle Scholar
  12. 12.
    Campbell, JC, Ikegami, N 1998The Art of Balance in Health PolicyCambridge University PressNew YorkGoogle Scholar
  13. 13.
    Konishi, T, Hiki, Y, Yamaguchi, T,  et al. 2000Costs of surgery for cholelithiasis at the 11 Japanese hospitalsJ. Jpn. Surg. Assoc.61587594 [in Japanese]Google Scholar
  14. 14.
    World Health Organization2000The World Health Report 2000.ParisGoogle Scholar
  15. 15.
    Jonsson, B, Zethraeus, N 2000Costs and benefits of laparoscopic surgery—a review of the literatureEur. J. Surg.5854856PubMedGoogle Scholar
  16. 16.
    Ikegami, N, Campbell, JC 1996Containing Health Care Costs in JapanThe University of Michigan University PressAnn ArborGoogle Scholar
  17. 17.
    Hirose, M, Imanaka, Y, Ishizaki, T,  et al. 2003How can we improve the quality of health care in Japan?—Learning from JCQHC hospital accreditationHealth Policy662949CrossRefPubMedGoogle Scholar
  18. 18.
    Ishizaki, T, Imanaka, Y, Hirose, M,  et al. 2002A first look at variations in use of breast conserving surgery at five teaching hospitals in JapanInt. J. Qual. Health Care14411418CrossRefPubMedGoogle Scholar
  19. 19.
    Campbell, P, Kane, NM. 1990Physician–management relationships at HCA: a case studyJ. Health Politics, Policy, Law15591605Google Scholar

Copyright information

© Société Internationale de Chirurgie 2005

Authors and Affiliations

  • Masahiro Hirose
    • 1
  • Yuichi Imanaka
    • 1
    Email author
  • Tatsuro Ishizaki
    • 1
  • Miho Sekimoto
    • 1
  • Yoshiaki Harada
    • 1
  • Kazuaki Kuwabara
    • 1
  • Kenshi Hayashida
    • 1
  • Eun-Hwan Oh
    • 1
  • S. Edward Evans
    • 1
  1. 1.Department of Healthcare Economics and Quality ManagementSchool of Public Health, Graduate School of Medicine, Kyoto UniversitySakyou-KuJapan

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