Time trend and variability of open versus laparoscopic cholecystectomy in patients with symptomatic gallstone disease
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The purpose of this study was to compare length of stay, as one of the efficacy indicators, and effectiveness, in terms of operative complications and mortality, between laparoscopic (LC) and open cholecystectomy, and to verify the 10-year temporal trends in the application of the LC technique in a large regional population.
This was a retrospective cohort study based on 73,853 hospital discharge records of cholecystectomies for gallstone disease (GD) in residents of the Veneto from 2001 to 2010, at both public and accredited private hospitals. The data are from a regional administrative database. The main epidemiological rates calculated, and expressed per 100,000 residents, were the cholecystectomy rate (CR) for gallstones by surgical technique (laparoscopic or open surgery), and the in-hospital mortality rate (MR), considered as the in-hospital MR regardless of the specific cause of death.
The CR was 139.7 higher in females, with a male-to-female ratio of 1:1.5. LC was performed more frequently in females than in males and in younger than in older patients. From 2001 to 2010, there was a significant linear rising trend in the use of LC, in fact during the period considered, the use of laparoscopic surgery increased significant (χ 2 trend: 316,917; p < 0.05), reaching 93.6 % of surgical procedures for gallstones during the year 2010.
There are still some age- and gender-related disparities in its usage, although LC is an increasingly widely applied, as effective procedure.
KeywordsCholecystitis Health care surveys Disease management Delivery of health care Surgical approach
Mario Saia, Domenico Mantoan, Alessandra Buja, Chiara Bertonecello, Tatjana Baldovin, Giampietro Callegaro, and Vincenzo Baldo have no conflict of interest or financial ties to disclose.
- 1.Festi D, Dormi A, Capodicasa S, Staniscia T, Attili AF, Loria P, Pazzi P, Mazzella G, Sama C, Roda E, Colecchia A (2008) Incidence of gallstone disease in Italy: results from a multicenter, population-based Italian study (the MICOL project). World J Gastroenterol 14(34):5282–5289PubMedCrossRefGoogle Scholar
- 4.Kuwabara K, Matsuda S, Ishikawa KB, Horiguchi H, Fujimori K (2010) Comparative quality of laparoscopic and open cholecystectomy in the elderly using propensity score matching analysis. Gastroenterol Res Pract 2010:490147Google Scholar
- 8.Keus F, Gooszen HG, van Laarhoven CJHM (2010) Open, small-incision, or laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis. An overview of Cochrane Hepato-Biliary Group reviews. Cochrane Database Syst Rev 20(1):CD008318. doi: 10.1002/14651858.CD008318
- 10.Epidemiologia e Ricerca Applicata, Atlante ERA (2009). Le procedure a rischio di inappropriatezza. http://www.atlantesanitario.it/index.php?option=com_content&view=article&id=82&Itemid=93. Accessed 1 Sep 2012
- 13.European charter on counteracting obesity, EUR/06/5062700/8 16 November 2006 61995 (Original: English)Google Scholar
- 14.ISTAT (2011) Italia in Cifre. www.istat.it/it/files/2011/06/italiaincifre2011.pdf. Accessed 1 Sep 2012
- 15.International Diabetes Federation (2012) Diabetes Atlas 2012 update. International Diabetes Federation, BrusselsGoogle Scholar
- 25.Dipartimento della Programmazione e dell’Ordinamento del Servizio Sanitario Nazionale Dir. Gen. della Programmazione sanitaria Ufficio VI. Rapporto annuale sull’’attività di ricovero ospedaliero. Dati SDO 2010Google Scholar
- 26.D Keus F, de Jonge T, Gooszen HG, Buskens E, van Laarhoven CJ (2009) Cost-minimization analysis in a blind randomized trial on small-incision versus laparoscopic cholecystectomy from a societal perspective: sick leave outweighs efforts in hospital savings. Trials 10:80. doi: 10.1186/1745-6215-10-80
- 29.Richards C, Edwards J, Culver D, Emori TG, Tolson J, Gaynes R, National Nosocomial Infections Surveillance (NNIS) System, Centers for Disease Control and Prevention (2003) Does using a laparoscopic approach to cholecystectomy decrease the risk of surgical site infection? Ann Surg 237(3):3CrossRefGoogle Scholar
- 34.Ospedalizzazione e Mobilità in Veneto: le Dimissioni Ospedaliere negli Anni 2000–2010 a cura di: Servizio Epidemiologico Regionale; Servizio Controllo Investimenti Prezzi Acquisti SSR. www.ser-veneto.it