Skip to main content


Log in

Nineteen-year trends in incidence and indications for laparoscopic cholecystectomy: the NY State experience

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript



Since the introduction of laparoscopic cholecystectomy (LC), there has been continued evolution in technique, instrumentation and postoperative management. With increased experience, LC has migrated to the outpatient setting. We asked whether increased availability and experience has impacted incidence of and indications for LC.


The New York (NY) State Planning and Research Cooperative System longitudinal administrative database was utilized to identify patients who underwent cholecystectomy between 1995 and 2013. ICD-9 and CPT procedure codes were extracted corresponding to laparoscopic and open cholecystectomy and the associated primary diagnostic codes. Data were analyzed as relative change in incidence (normalized to 1000 LC patients) for respective diagnoses.


From 1995 to 2013, 711,406 cholecystectomies were performed in NY State: 637,308 (89.58 %) laparoscopic. The overall frequency of cholecystectomy did not increase (1.23 % increase with a commensurate population increase of 6.32 %). Indications for LC during this time were: 72.81 % for calculous cholecystitis (n = 464,032), 4.88 % for biliary colic (n = 31,124), 8.98 % for acalculous cholecystitis (n = 57,205), 3.01 % for gallstone pancreatitis (n = 19,193), and 1.59 % for biliary dyskinesia (n = 10,110). The incidence of calculous cholecystitis declined (−20.09 %, p < 0.0001) between 1995 and 2013; meanwhile, other diagnoses increased in incidence: biliary colic (+54.96 %, p = 0.0013), acalculous cholecystitis (+94.24 %, p < 0.0001), gallstone pancreatitis (+107.48 %, p < 0.0001), and biliary dyskinesia (+331.74 %, p < 0.0001). Outpatient LC incidence catapulted to 48.59 % in 2013, from 0.15 % in 1995, increasing >320-fold. Analysis of LC through 2014 revealed increasing rates of digestive, infectious, respiratory, and renal complications, with overall cholecystectomy complication rates of 9.29 %.


A shifting distribution of operative indications and increasing rates of complications should prompt careful consideration prior to surgery for benign biliary disease. For what is a common procedure, LC carries substantial risk of complications, thus requiring the patient to be an active participant and to share in the decision-making process.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Centers for Disease Control and Prevention. National Center for Health Statistics. (2016) Health data interactive. Accessed 11 Mar 2016

  2. National Center for Health Statistics (2015). Health, United States, 2014: with special feature on adults aged 55–64. Hyattsville, MD. Accessed 11 Mar 2016

  3. Wier LM, Steiner CA, Owens PL (2015) Surgeries in hospital-owned outpatient facilities, 2012. HCUP statistical brief #188. February 2015. Agency for Healthcare Research and Quality, Rockville, MD. Accessed 11 Mar 2016

  4. Pulvirenti E, Toro A, Gagner M, Mannino M, Di Carlo I (2013) Increased rate of cholecystectomies performed with doubtful or no indications after laparoscopy introduction: a single center experience. BMC Surg. doi:10.1186/1471-2482-13-17

    PubMed  PubMed Central  Google Scholar 

  5. Talseth A, Lydersen S, Skjedlestad F, Hveem K, Edna TH (2014) Trends in cholecystectomy rates in a defined population during and after the period of transition from open to laparoscopic surgery. Scand J Gastroenterol. doi:10.3109/00365521.2013.853828

    PubMed  Google Scholar 

  6. NIH Consensus Conference (1993) Gallstones and laparoscopic cholecystectomy. JAMA 269(8):1018–1024

    Article  Google Scholar 

  7. Table 1. Annual Estimates of the Resident Population for the United States, Regions, States, and Puerto Rico: April 1, 2010 to July 1, 2014 (NST-EST2014-01); Source: U.S. Census Bureau, Population Division; Release Date: December 2014; Accessed 20 June 2016.

  8. Table 2. Intercensal Estimates of the Resident Population by Sex and Age for New York: April 1, 2000 to July 1, 2010 (ST-EST00INT-02-36); Source: U.S. Census Bureau, Population Division; Release Date: October 2012; Accessed 20 June 2016.

  9. Table CO-EST2001-12-00 – Time Series of Intercensal State Population Estimates: April 1, 1990 to April 1, 2000; Source: Population Division, U.S. Census Bureau; Release Date: April 11, 2002; Accessed 20 June 2016.

  10. Steiner CA, Bass EB, Talamini MA, Pitt HA, Steinberg EP (1994) Surgical rates and operative mortality for open and laparoscopic cholecystectomy in Maryland. N Engl J Med 330(6):403–408

    Article  CAS  PubMed  Google Scholar 

  11. Enochsson L, Thulin A, Osterberg J, Sandblom G, Persson G (2013) The swedish registry of gallstone surgery and endoscopic retrograde cholangiopancreatography (GallRiks): a nationwide registry for quality assurance of gallstone surgery. JAMA Surg 148(5):471–478. doi:10.1001/jamasurg.2013.1221

    Article  PubMed  Google Scholar 

  12. Nenner RP, Imperato PJ, Rosenberg C, Ronberg E (1994) Increased cholecystectomy rates among Medicare patients after the introduction of laparoscopic cholecystectomy. J Commun Health 19(6):409–415

    Article  CAS  Google Scholar 

  13. Legorreta AP, Silber JH, Costantino GN, Kobylinski RW, Zatz SL (1993) Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy. JAMA 270(12):1429–1432

    Article  CAS  PubMed  Google Scholar 

  14. Halbert C, Pagkratis S, Yang J, Meng Z, Altieri MS, Parikh P, Pryor A, Talamini M, Telem DA (2015) Beyond the learning curve: incidence of bile duct injuries following laparoscopic cholecystectomy normalize to open in the modern era. Surg Endosc. doi:10.1007/s00464-015-4485-2

    Google Scholar 

  15. Stinton LM, Shaffer EA (2012) Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver 6(2):172–187. doi:10.5009/gnl.2012.6.2.172

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cotton PB, Elta GH, Carter CR, Pasricha PJ, Corazziari ES (2016) Rome IV. Gallbladder and sphincter of Oddi disorders. Gastroenterology. doi:10.1053/j.gastro.2016.02.033 [Epub ahead of print]

    Google Scholar 

  17. Ponsky TA, Desagun R, Brody F (2005) Surgical therapy for biliary dyskinesia: a meta-analysis and review of the literature. J Laparoendosc Adv Surg Tech A 15:439–442

    Article  PubMed  Google Scholar 

  18. Gurusamy KS, Junnarkar S, Farouk M, Davidson BR (2009) Cholecystectomy for suspected gallbladder dyskinesia. Cochrane Database Syst Rev 21(1):CD007086. doi:10.1002/14651858.CD007086

  19. Bielefeldt K (2013) The rising tide of cholecystectomy for biliary dyskinesia. Aliment Pharmacol Ther 37(1):98–106. doi:10.1111/apt.12105 [Epub 2012 Oct 28]

    Article  CAS  PubMed  Google Scholar 

  20. Preston JF, Diggs BS, Dolan JP, Gilbert EW, Schein M, Hunter JG (2015) Biliary dyskinesia: a surgical disease rarely found outside the United States. Am J Surg. doi:10.1016/j.amjsurg.2015.01.003

    PubMed  Google Scholar 

  21. Richmond BK, DiBaise J, Ziessman H (2013) Utilization of cholecystokinin cholescintigraphy in clinical practice. J Am Coll Surg. doi:10.1016/j.jamcollsurg.2013.02.034

    PubMed  Google Scholar 

  22. Ziessman HA (2012) Sincalide cholescintigraphy–32 years later: evidence-based data on its clinical utility and infusion methodology. Semin Nucl Med. doi:10.1053/j.semnuclmed.2011.10.002

    PubMed  Google Scholar 

  23. Dave RV, Pathak S, Cockbain AJ, Lodge JP, Smith AM, Chowdhury FU, Toogood GJ (2015) Management of gallbladder dyskinesia: patient outcomes following positive 99 m technetium (Tc)-labelled hepatic iminodiacetic acid (HIDA) scintigraphy with cholecystokinin (CCK) provocation and laparoscopic cholecystectomy. Clin Radiol. doi:10.1016/j.crad.2014.12.006

    PubMed  Google Scholar 

  24. Shaffer E (2003) Acalculous biliary pain: new concepts for an old entity. Dig Liver Dis 35(Suppl 3):S20–S255

    Article  PubMed  Google Scholar 

Download references


We would like to acknowledge statistical consultation and support from the Biostatistical Consulting Core at the School of Medicine, Stony Brook University. Additionally, we would also like to acknowledge input and guidance in study planning from Stony Brook University’s Surgical Outcome Analysis Research (SOAR) Collaborative.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Vamsi V. Alli.

Ethics declarations


Drs. Vamsi Alli, Jie Yang, Andrew Bates, and Mark Talamini and Ms. Jianjin Xu have no conflicts of interest. Dr. Aurora Pryor serves as a consultant for Apollo, Intuitive and Freehold Medical, is an investigator with Baronova and Obalon, and serves as a speaker for Ethicon and Gore. Dr. Dana Telem serves as a consultant for Medtronic, Gore and Ethicon and receives research support from Cook and Surgiquest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alli, V.V., Yang, J., Xu, J. et al. Nineteen-year trends in incidence and indications for laparoscopic cholecystectomy: the NY State experience. Surg Endosc 31, 1651–1658 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: