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Hospital reported complications of laparoscopic cholecystectomy among Medicare and Medicaid patients

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The purpose of this study was to initiate a hospital-based case review of all laparoscopic cholecystectomies performed on Medicare and Medicaid patients in New York State in 1991 where there were one or more complications. Another purpose was to facilitate efforts by hospitals to monitor the performance of laparoscopic cholecystectomy through an educational process of data-sharing.

There were 2,940 Medicare and 1,108 Medicaid cholecystectomies in New York State in 1991. Of these, 351 (11.9%) Medicare and 107 (9.7%) Medicaid patients were reported as having complications. The complication rate for Medicare patients was slightly lower than that observed (15.8%) in an epidemiologic study of Medicare patients in New York State who underwent laparoscopic cholecystectomy during the period January 1, 1990–June 30, 1991.

Both of these observed rates for Medicare patients are higher than the mean 6.0% complication rate reported for open cholecystectomy in the literature. These increased rates may in part be due to age related risk factors present among Medicare patients. The absence of age related risk factors may also largely account for the lower laparoscopic cholecystectomy complication rate (9.7%) observed among Medicaid patients.

The complication rate of 9.7% for Medicaid patients is similar to rates reported in other recent studies. The 11.9% complication rate for Medicare patients is higher than that reported in other recent studies. However, careful patient selection, the absence of age related risk factors, and greater surgical experience may account for the lower complication rates reported in some published series.

Overall, the coding of complications was found to be accurate. The coding of laparoscopic cholecystectomy was found to be slightly flawed.

Few of the adverse events leading to complications were deemed preventable by the hospitals. Surgeons often dealt with intraoperative problems by converting to a conventional open procedure.

Hospitals should continue to monitor their experience with laparoscopic cholecystectomies over time, and should provide educational feedback to their medical staffs regarding these findings.

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Raphael P. Nenner, M.D. is Vice President for Medical Affairs for the Island Peer Review Organization (IPRO), 1979 Marcus Ave, Lake Success, NY 11042; Pascal James Imperato, M.D. is Medical Director for Research, Development, and Epidemiology (IPRO) and Professor and Chairman, Department of Preventive Medicine and Community Health, State University of New York (SUNY), Health Science Center at Brooklyn, 450 Clarkson Ave, Brooklyn, NY 11203; Theodore O. Will, M.P.A., is Executive Vice President (IPRO); Harriet Starr, M.A. is Vice-President for Management Information Systems (IPRO); Harry S. Soroff, M.D., (IPRO) and Professor, Department of Surgery, State University of New York, Health Sciences Center at Stony Brook, Stony Brook, NY 11794- 3399.

We wish to acknowledge the assistance of Gary B. Beringer, Dr. P.H., Director, Department of Data Analysis, Island Peer Review Organization (IPRO); John Zetsche, M.A., Research Analyst, and H. Peter Lee, S.B., Research Analyst, IPRO.

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Nenner, R.P., Imperato, P.J., Will, T.O. et al. Hospital reported complications of laparoscopic cholecystectomy among Medicare and Medicaid patients. J Community Health 18, 253–260 (1993).

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