Profiling Hospital Performance of Laparoscopic Cholecystectomy Based on the Administrative Data of Four Teaching Hospitals in Japan
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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.
KeywordsLaparoscopic Cholecystectomy Cholelithiasis Open Cholecystectomy Hospital Factor Laparoscopic Cholecystectomy Procedure
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).
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